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Karpale Begleitläsionen bei dislozierter distaler Radiusfraktur

Eine systematische Erfassung durch präoperative CT- und MRT-Untersuchung

Carpal lesions associated with dislocated fractures of the distal radius

A systematic screening of 104 fractures using preoperative CT and MRI

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Zusammenfassung

Hintergrund

Die Ergebnisse nach operativ behandelten dislozierten, distalen Radiusfrakturen sind begrenzt. Dabei korrelieren die radiographischen Ergebnisse nicht gut mit den funktionellen Ergebnissen. Diese Tatsache legt die Vermutung nahe, dass radiographisch nicht darstellbare, zusätzliche karpale Primärläsionen dafür verantwortlich sind. Die vorliegende Studie soll klären, inwieweit karpale begleitende Läsionen mit dislozierten distalen Radiusfrakturen assoziiert sind.

Material und Methode

Es wurde eine konsekutive Serie von 104 Patienten mit dislozierten distalen Radiusfrakturen eingeschlossen. Das verletzte Handgelenk wurde radiographisch, computertomographisch und MR-tomographisch in Hinblick auf zusätzliche Verletzungen untersucht.

Ergebnisse

Radiographisch zeigten sich nach AO 51/104 Frakturen als Typ A, 10/104 als Typ B und 39 als Typ C. CT-morphologisch waren nur 5 der 51 Typ-A-Frakturen reine metaphysäre Frakturen. MR-tomographisch wiesen alle als Typ A klassifizierten Frakturen ligamentäre Verletzungen auf. Die MRT-Untersuchung ergab 77/104 akute Läsionen des TFCC und 19/104 skapholunäre Bandrupturen.

Schlussfolgerung

Die Ergebnisse der Studie stützen die Hypothese, dass jede dislozierte distale Radiusfraktur eine zusätzliche Läsion radiographisch nicht erkennbarer karpaler Strukturen mit sich bringt.

Abstract

Background

The functional outcome of surgically treated dislocated fractures of the distal radius is limited and does not correlate with radiographic results. Additional carpal lesions are assumed to be the cause. This study has evaluated which carpal lesions are associated with dislocated fractures of the distal radius.

Material and methods

A total of 104 consecutive patients with dislocated fractures of the distal radius were included in the study. The injured wrist was examined by radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine additional carpal lesions.

Results

Radiographically 51 of the 104 fractures presented as type A according to the AO classification, 10 as type B and 39 as type C. The CT scan detected that only 5 of the 51 type A fractures were exclusively metaphyseal fractures. All type A fractures were associated with ligamental lesions in MRI.

Conclusions

The results of the study confirm the hypothesis that every dislocated fracture of the distal radius is a combined carpal trauma associated with additional osseous and/or ligamental lesions.

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Literatur

  1. Arora R, Lutz M, Hennerbichler A et al (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21:316–322

    Article  PubMed  Google Scholar 

  2. Bacorn RW, Kurtzke JF (1953) Colles‘ fracture: a study of two thousand cases from the New York State workmen’s compensation board. J Bone Joint Surg Am 35:643–658

    PubMed  Google Scholar 

  3. Bühren V (1998) Radiusfraktur. Trauma Berufkrankh 1:5–14

    Google Scholar 

  4. Campbell DA (2000) Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate. J Hand Surg Br 25:528–534

    Article  CAS  PubMed  Google Scholar 

  5. Catalano LW, Barron OA, Glickel SZ (2004) Assessment of articular displacement of distal radius fracture. Clin Orthop Rel Res 423:79–84

    Article  Google Scholar 

  6. Cautilli GP, Wehbé MA (1991) Scapho-lunate distance and cortical ring sign. J Hand Surg Am 16(3):501–503

    Article  CAS  PubMed  Google Scholar 

  7. Chen NC, Jupiter JB (2007) Management of Distal Radial Fractures. J Bone Joint Surg Am 89:2051–2062

    Article  PubMed  Google Scholar 

  8. Cole RJ, Bindra RR, Evanoff BA et al (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 22:792–800

    Article  CAS  PubMed  Google Scholar 

  9. Cooney WP, Dobyns JH, Linscheid RL (1980) Complications after Colles‘ fracture. J Bone Joint Surg Am 62:613–619

    PubMed  Google Scholar 

  10. Ehalt W (1935) Die Bruchformen am unteren Ende der Speiche und Elle. Arch Orth Unfall 35:397–465

    Article  Google Scholar 

  11. Fischer M, Denzler C, Sennwald G (1996) Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases. Swiss Surg 2:269–272

    CAS  PubMed  Google Scholar 

  12. Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89:2334–2340

    Article  PubMed  Google Scholar 

  13. Geissler WB, Fernandez DL, Lamey DM (1996) Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop 327:135–146

    Article  PubMed  Google Scholar 

  14. Gilula LA, Weeks PM (1978) Post-traumatic ligamentous instabilities of the wrist Radiology. Radiology 129(3):641–651

    CAS  PubMed  Google Scholar 

  15. Gliatis JD, Plessas SJ, Davis TR (2000) Outcome of distal radial fractures in young adults. J Hand Surg Br 25:535–543

    Article  CAS  PubMed  Google Scholar 

  16. Goldfarb CA, Yin Y, Gilula LA et al (2001) Wrist fractures: what the clinician wants to know. Radiology 219:11–28

    Article  CAS  PubMed  Google Scholar 

  17. Jupiter JB, Ring D, Weitzel PP (2002) Surgical treatment of redisplaced Fractures of the distal radius in patients older than 60 years. J Hand Surg Am 27(4):714–723

    Article  PubMed  Google Scholar 

  18. Kordasiewicz B, Pomianowski S, Orlowski J, Rapala K (2006) Interosseous ligaments and TFCC lesions in intraarticular distal radius fractures – radiographic versus arthroscopic evaluation. Ortop Traumatol Rehabil 8:263–267

    PubMed  Google Scholar 

  19. Koval KJ, Harrast JJ, Anglen JO, Weinstein JN (2008) Fractures of the distal part of the radius. The evolution of practice over time. Where is the evidence? J Bone Joint Surg Am 90:1855–1861

    Article  PubMed  Google Scholar 

  20. Laulan J, Bismuth JP (1999) Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year. A prospective study of 95 cases. Acta Orthop Belg 65:418–423

    CAS  PubMed  Google Scholar 

  21. Lindau T, Adlercreutz C, Aspenberg P (2000) Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 25:464–468

    Article  CAS  PubMed  Google Scholar 

  22. Lindau T, Hagberg L, Adlercreutz C et al (2000) Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop 376:229–235

    Article  PubMed  Google Scholar 

  23. Lipton HA, Wollstein R (1996) Operative treatment of intraarticular distal radial fractures. Clin Orthop 327:110–124

    Article  PubMed  Google Scholar 

  24. Lozano-Calderón SA, Souer S, Mudgal C et al (2008) Wrist mobilization following volar plate fixation of fractures of the distal part of the radius, J Bone Joint Surg Am 90(6):1297–1304

    Google Scholar 

  25. Meier R, Jansen H, Uhl M (2009) Radiologische Diagnostik beim Handgelenktrauma. Radiologe 49:1063–1084

    Article  CAS  PubMed  Google Scholar 

  26. Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, Berlin Heidelberg New York

  27. Oneson SR, Scales LM, Timins ME et al (1996) MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions. Radiographics 16:97–106

    Article  CAS  PubMed  Google Scholar 

  28. Poigenfürst L (1980) Brüche am distalen Unterarmende. Einteilung der Bruchformen und Indikation. H Unfallheilkunde 148:53–59

    Google Scholar 

  29. Prommersberger KJ, Schoonhoven J van (2008) Störungen des distalen Radioulnargelenkes nach distaler Radiusfraktur. Unfallchirurg 111:173–186

    Article  PubMed  Google Scholar 

  30. Pruitt DL, Gilula LA, Manske PR, Vannier MW (1994) Computed tomography scanning with image reconstruction in evaluation of distal radius fractures. J Hand Surg Am 19:720–727

    Article  CAS  PubMed  Google Scholar 

  31. Rappold G, Leixnering M, Pezzei C (2001) Carpal injuries associated with distal radius fractures. Diagnosis and therapy. Handchir Mikrochir Plast Chir 33:221–228

    Article  CAS  PubMed  Google Scholar 

  32. Rose S, Frank J, Marzi I (1999) Diagnostic and therapeutic significance of arthroscopy in distal radius fracture. Zentralbl Chir 124:984–992

    CAS  PubMed  Google Scholar 

  33. Schädel-Hopfner M, Bohringer G, Junge A et al (2001) Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius. Handchir Mikrochir Plast Chir 33:229–233

    Article  PubMed  Google Scholar 

  34. Schädel-Hopfner M, Iwinska-Zelder J, Bohringer G et al (2001) MRI or arthroscopy in the diagnosis of scapholunate ligament tears in fractures of the distal radius? Handchir Mikrochir Plast Chir 33:234–238

    Article  PubMed  Google Scholar 

  35. Smektala R, Endres HG, Dasch B et al (2008) Die stationäre Behandlungsqualität der distalen Radiusfraktur in Deutschland. Unfallchirurg 112:46–54

    Article  Google Scholar 

  36. Stoffelen D, DeSmet L, Broos P (1998) The importance of the distal radioulnar joint in distal radial fractures. J Hand Surg Br 23:507–511

    Article  CAS  PubMed  Google Scholar 

  37. Tang JB, Shi D, Gu YQ, Zhang QG (1996) Can cast immobilization successfully treat scapho-lunate dissociation associated with distal radius fractures? J Hand Surg Am 21:583–590

    Article  CAS  PubMed  Google Scholar 

  38. Towfigh H, Hirner R, Langer M, Friedel R (2011) Handchirurgie, Bd. 1–2. Springer, Berlin Heidelberg New York, S 769–818

  39. Warwick D, Field J, Prothero D et al (1993) Function ten years after Colles‘ fracture. Clin Orthop Rel Res 195:270–274

    Google Scholar 

  40. Wirth CJ, Mutschler W, Bischoff HP et al (2010) Komplikationen in Orthopädie und Unfallchirugie. Thieme, Stuttgart, S 247–255

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Authors and Affiliations

  1. Orthopädisch-Unfallchirurgisches Zentrum, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland

    R. Gologan, V.M. Ginter, N. Ising, U. Obertacke &  U. Schreiner

  2. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Mannheim, Deutschland

    A.K. Kilian

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  1. R. Gologan
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  2. V.M. Ginter
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  3. N. Ising
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  4. A.K. Kilian
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  5. U. Obertacke
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  6. U. Schreiner
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Correspondence to U. Schreiner.

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Gologan, R., Ginter, V., Ising, N. et al. Karpale Begleitläsionen bei dislozierter distaler Radiusfraktur. Unfallchirurg 117, 48–53 (2014). https://doi.org/10.1007/s00113-012-2264-2

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