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Obere Extremität

, Volume 11, Issue 4, pp 218–227 | Cite as

Das chronisch dezentrierte Ellenbogengelenk

Wieviel knöcherne Rekonstruktion, ligamentäre Rekonstruktion, wann Fixateur?
  • Jan Geßmann
  • Matthias Königshausen
  • Alexander von Glinski
  • Valentin Rausch
  • Thomas A. Schildhauer
  • Dominik Seybold
Übersicht

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.

Schlüsselwörter

Ellenbogengelenk Luxation Instabilität Koronoid Radiuskopf 

Chronic elbow decentration

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

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.

Keywords

Elbow joint Dislocation Instability Coronoid Radial head 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Geßmann, M. Königshausen, A. von Glinski, V. Rausch, T.A. Schildhauer und D. Seybold geben 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-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Jan Geßmann
    • 1
  • Matthias Königshausen
    • 1
  • Alexander von Glinski
    • 1
  • Valentin Rausch
    • 1
  • Thomas A. Schildhauer
    • 1
  • Dominik Seybold
    • 1
  1. 1.Chirurgische Klinik und PoliklinikBG Universitätsklinikum BergmannsheilBochumDeutschland

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