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Das chronisch dezentrierte Ellenbogengelenk

Wieviel knöcherne Rekonstruktion, ligamentäre Rekonstruktion, wann Fixateur?

Chronic elbow decentration

How much bony reconstruction, ligament reconstruction, when to use a fixator?

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Zusammenfassung

Eine chronische Dezentrierung des Ellenbogengelenks ist selten und beruht meist auf einem Substanzdefekt der knöchernen Stabilisatoren, wobei ein Koronoiddefekt die häufigste Ursache darstellt. Bewegungseinschränkung und Schmerz sind die Folge der Gelenkdislokation, von Knorpelschäden, Kontrakturen und Vernarbungen. Primäres Behandlungsziel stellt die Rezentrierung des Gelenks mit Wiedererlangen eines funktionellen Bewegungsausmaßes dar. Die gelenkrekonstruktiven Verfahren sind aufwendig und werden z. T. kontrovers diskutiert. Das grundlegende Behandlungsprinzip beruht auf der stabilen Rekonstruktion des humeroulnaren Gelenks. Im Behandlungsalgorithmus erfolgt zunächst die Rekonstruktion der knöchernen Stabilisatoren über einen Koronoidaufbau und/oder eine Radiuskopfprothese. Im Anschluss müssen Insuffizienzen weichteiliger Stabilisatoren beurteilt und adressiert werden. Ein Bewegungsfixateur dient dem Schutz der Rekonstruktion und ermöglicht eine unmittelbar postoperative Mobilisation des Ellenbogengelenks. Als negative Prognosefaktoren sind eine verzögerte Gelenkrekonstruktion, eine persistierende Gelenkinstabilität und ein Arthrosenachweis definiert worden.

Abstract

Chronic elbow decentration is an uncommon but difficult-to-treat condition that is mainly caused by insufficiency of the osseous constraints. Among these fractures, coronoid defects constitute the main reasons for posterior subluxation. Pain and elbow stiffness are the result of joint malalignment, articular and cartilage damage, soft tissue contractures, and scarring. Reconstructive procedures are complex and the different treatment options are discussed controversially in small patient series. The basic principle is based on restoring a stable ulnohumeral joint. Reconstruction of the osseous stabilizers with coronoid reconstruction and/or radial head arthroplasty is the first step in the treatment protocol. Any soft tissue deficiencies must be recognized subsequently to the bony reconstruction and addressed if necessary. The application of a hinged external fixator protects the reconstruction in the early healing process and allows immediate postoperative mobilization of the elbow. Delay of reconstruction, persistent joint instability, and arthrosis at the time of surgery have been identified as negative outcome predictors.

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Correspondence to Jan Geßmann.

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J. Geßmann, M. Königshausen, A. von Glinski, V. Rausch, T.A. Schildhauer und D. Seybold geben an, dass kein Interessenkonflikt besteht.

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Geßmann, J., Königshausen, M., von Glinski, A. et al. Das chronisch dezentrierte Ellenbogengelenk. Obere Extremität 11, 218–227 (2016). https://doi.org/10.1007/s11678-016-0379-8

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