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Der Orthopäde

, Volume 47, Issue 8, pp 655–662 | Cite as

Nahttechniken am Diskus

  • H.-G. Tünnerhoff
Leitthema

Zusammenfassung

Traumatische Rupturen des TFCC können unterteilt werden in Läsionen, die keine Instabilität des DRUG verursachen und Läsionen, die einer Avulsion der ulnoradialen Bänder entsprechen und zu einer klinisch – zumindest bei subtiler Untersuchung – nachweisbaren Instabilität des DRUG führen. Zur Behandlung der Instabilität wurden in den letzten Jahren Verfahren zur Reinsertion des TFCC bzw. des ulnoradialen Bandapparats entwickelt, die verlässlich die Schmerzen bessern oder beseitigen und die Funktion und Belastbarkeit des Arms weitgehend wiederherstellen. Allerdings muss nicht jede traumatische Ruptur operativ versorgt werden. Eine Reinsertion ist auch nach mehreren Monaten noch möglich. Kontraindikationen, besonders Fehlstellungen des Knochens nach früherer Unterarmfraktur oder Ulna-Impaction-Situation, sind sorgfältig zu beachten.

Diagnostik und Operationsindikation werden diskutiert sowie eine Übersicht über die verschiedenen Techniken gegeben.

Schlüsselwörter

Bänder Gelenkinstabilität Distales Radioulnargelenk Schmerz Triangular fibrocartilage complex 

Abkürzungen

DRUG

Distales Radioulnargelenk

ECU

Extensor carpi ulnaris

PDS

Polydioxanon

PSU

Processus styloideus ulnae

SSF

Strecksehnenfach

TFCC

„Triangular fibrocartilage complex“

UVO

Ulnaverkürzungsosteotomie

Suture techniques for TFCC

Abstract

Traumatic ruptures of the triangular fibrocartilaginous complex (TFCC) may cause ulnar-sided wrist pain. These ruptures frequently lead to instability of the distal radioulnar joint (DRUJ) because the ulnoradial ligaments, which are interwoven with the TFCC, are avulsed from the fovea of the ulnar head or—very rarely—from the radius. Conservative treatment may be sufficient, and some instability may be tolerated over time. In the case of persistent pain, operative repair by reattachment of the TFCC and, thereby, the ligaments to the previously debrided bone in the fovea is effective in reestablishing a stable, pain free DRUJ. Several arthroscopic and open repair techniques have been described in the last years. Contraindications such as the ulna—plus—situation or instability due to even minor degrees of malunion after fractures of the forearm bones must be kept in mind.

An overview is given of the pathological anatomy, diagnosis, indications and suturing techniques.

Keywords

Ligaments Joint instability Distal radioulnar joint Pain Triangular fibrocartilage complex 

Notes

Danksagung

Herzlichen Dank an Anna Kiraly und an Dr. Szabolz Kiraly für die anschaulichen Zeichnungen.

Einhaltung ethischer Richtlinien

Interessenkonflikt

H.-G. Tünnerhoff gibt an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Praxis und Belegabteilung für Hand- und FußchirurgieKrankenhaus MarbachMarbach am NeckarDeutschland

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