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Diagnostik des Skaphoids

Fraktur, Pseudarthrose, Durchblutung, Perfusion

Diagnosis of the scaphoid bone

Fractures, nonunion, circulation, perfusion

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Zusammenfassung

Frakturen des Os scaphoideum sind mit 60 % die häufigsten Frakturen der Handwurzelknochen und stellen ca. 2–3 % aller Frakturen dar. Meist heilen die Frakturen bei adäquater Behandlung vollständig aus. Bei fehlender Ruhigstellung oder nicht diagnostizierten bzw. übersehenen Frakturen steigt die Wahrscheinlichkeit einer Pseudoarthrose im weiteren Verlauf an.

Bei der initialen Röntgendiagnostik werden ca. 70–80 % der Kahnbeinfrakturen festgestellt. Um eine Fraktur sicher auszuschließen oder zu bestätigen, sollte, bei entsprechender Klinik und negativem Röntgenbild, eine weiterführende Diagnostik mittels Mehrzeilenspiral-CT (MSCT) oder MRT erfolgen, wobei der MSCT die höhere Bedeutung zukommt. Neben der Frakturbeschreibung gehört die Einteilung der Pseudoarthrosestadien ebenfalls zu den Aufgaben der MSCT. Wegweisend zur Beurteilung der Vitalität der Fragmente ist die kontrastmittelverstärkte MRT-Untersuchung.

Abstract

The clinical relevance of scaphoid bone fractures is reflected by their high incidence, accounting for approximately 60 % among carpal fractures and for 2–3 % of all fractures. With adequate therapy most scaphoid bone fractures heal completely without complications. Insufficient immobilization or undiagnosed fractures increase the risk of nonunion and the development of pseudarthrosis.

X-ray examination enables initial diagnosis of scaphoid fracture in 70–80 % of cases. Positive clinical symptoms by negative x‑ray results require further diagnostics by multi-slice spiral CT (MSCT) or MRI to exclude or confirm a fracture. In addition to the diagnosis and description of fractures MSCT is helpful for determining the stage of nonunion. Contrast enhanced MRI is the best method to assess the vitality of scaphoid fragments.

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Authors and Affiliations

  1. Institut für Radiologie und Neuroradiologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland

    T. Kahl, F. K. Razny, J. P. Benter, K. Hegenscheid & S. Mutze

  2. Institut für Radiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    K. Hegenscheid & S. Mutze

  3. Institut für vegetative Anatomie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    K. Mutig

  4. Klinik für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Deutschland

    A. Eisenschenk

  5. Hand- und funktionelle Mikrochirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    A. Eisenschenk

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  1. T. Kahl
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  2. F. K. Razny
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  3. J. P. Benter
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  4. K. Mutig
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  5. K. Hegenscheid
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  6. S. Mutze
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  7. A. Eisenschenk
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Correspondence to T. Kahl.

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Interessenkonflikt

T. Kahl, F. K. Razny, J. P. Benter, K. Mutig, K. Hegenscheid, S. Mutze und A. Eisenschenk geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kahl, T., Razny, F.K., Benter, J.P. et al. Diagnostik des Skaphoids. Orthopäde 45, 938–944 (2016). https://doi.org/10.1007/s00132-016-3333-y

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  • DOI: https://doi.org/10.1007/s00132-016-3333-y

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