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Die laterale Klavikulafraktur – Grundlagen, OP-Indikationen, Versorgungstechniken

Lateral clavicular fractures: Principles, indications for surgery and treatment techniques

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Zusammenfassung

Frakturen der lateralen Klavikula sind insgesamt selten. Lediglich Frakturen des Typ II nach Neer bzw. Typ IIa nach Jäger/Breitner stellen eine OP-Indikation dar. Für die operative Versorgung stehen zahlreiche Implantate und OP-Techniken zur Verfügung. „Klassische“ Verfahren wie die K-Draht-Osteosynthese, die das Akromioklavikular (AC)-Gelenk übergreifende Transfixation und die Hakenplatte sind mit höheren Komplikationen verbunden und daher nur noch zurückhaltend einzusetzen. Analog zur Versorgung der AC-Gelenkluxation lässt sich ein Trend zu minimalinvasiven Verfahren erkennen. Die klinischen Ergebnisse sind gut, die Komplikationsrate im bisher verfügbaren kurzzeitigen Verlauf niedrig. Eine Kombination aus winkelstabiler Plattenosteosynthese mittels 3,5 mm T-Platte und eine Augmentation der korakoklavikulären (CC) Bänder stellt die biomechanisch stabilste Variante dar und ist ebenfalls mit guten klinisch-radiologischen Resultaten verbunden. Präformierte winkelstabile Implantate sind häufig mit Weichteilirritationen verbunden und müssen daher häufiger im Verlauf entfernt werden.

Abstract

Fractures of the lateral clavicle are a rare entity and can usually be treated conservatively. Only dislocated fractures with disrupted coracoclavicular (CC) ligaments may require operative treatment. Many different surgical techniques have been described. The use of hook plates and k-wires is associated with higher complication rates. Similar to acromioclavicular (AC) joint dislocation, there is a trend towards minimally invasive and arthroscopically assisted procedures. The functional results are promising and the complication rates are low. From a biomechanical point of view, a combination of locked plate fixation and minimally invasive CC ligament reconstruction provides the highest stability. Newly developed preshaped angular stable implants may provide higher stability but are associated with implant-related soft tissue irritation and hardware removal is required more frequently.

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Correspondence to Dr. med. Benedikt Schliemann.

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Schliemann, B., Breiter, S., Theisen, C. et al. Die laterale Klavikulafraktur – Grundlagen, OP-Indikationen, Versorgungstechniken. Obere Extremität 9, 222–228 (2014) doi:10.1007/s11678-014-0244-6

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Schlüsselwörter

  • Laterale Klavikulafraktur
  • Neer-Klassifikation
  • Jäger und Breitner
  • „Tightrope”
  • MINAR

Keywords

  • Lateral clavicle fractures
  • Neer classification
  • Jäger and Breitner
  • Tightrope
  • MINAR