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Arthroskopisch unterstützte Frakturversorgung am Handgelenk

Arthroscopy-assisted management of wrist fractures

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Zusammenfassung

Die distale Radiusfraktur ist die häufigste Fraktur des Menschen. Die operative Versorgung wird in vielen Fällen bereits als protektive Maßnahme gegen eine sekundäre Dislokation angestrebt. Somit wird in zunehmendem Maße die Indikation zur Operation gestellt. Die Versorgung konzentriert sich ausschließlich auf den ossären Aspekt, der durch die radiologische Diagnostik beurteilbar ist. Auf eine weiterführende Diagnostik der Weichteilstrukturen und des Gelenkknorpels wird bis heute weitestgehend verzichtet, obwohl die zur Fraktur führende Energie in vielen Fällen das Potential zur Verletzung weiterer Strukturen hat. Die zunehmende Verbreitung der Handgelenkarthroskopie eröffnet hinsichtlich intraartikulärer Begleitverletzungen neue Möglichkeiten. Eine assistierte Frakturreposition unter direkter visueller Darstellung erlaubt sowohl die Mitversorgung etwaiger Diskus- oder Ligamentverletzungen als auch ein ausgedehntes Débridement und die Entfernung von freien Gelenkkörpern.

Abstract

Distal radius fractures are the most common fractures in humans and early surgical intervention with modern plating systems is becoming increasingly more established to avoid secondary dislocation. Even fractures with slight dislocations are adequately stabilized and the affinity for surgical intervention and plating procedures is applied to secure these simple fractures. In this aspect the surgical indications are significantly dependent on X-ray examination results. Further diagnostics with respect to ligamentous and soft tissue injury are the exception although the impact energy which creates osseus fractures is sufficient by far to destroy functional soft tissue, cartilage and ligaments. The ongoing development of wrist arthroscopy enables new possibilities especially concerning concomitant articular involvement of distal radius fractures. Arthroscopy-assisted reduction and stabilization as well as minimally invasive soft tissue repair and loose body removal seem to be adequate methods to improve the surgical treatment of distal radius fractures.

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Literatur

  1. Jupiter JB, Marent-Huber M (2009) Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am 91(1):55–65

    Article  PubMed  Google Scholar 

  2. Chen NC, Jupiter JB (2007) Management of distal radial fractures. J Bone Joint Surg Am 89(9):2051–2062

    Article  PubMed  Google Scholar 

  3. McQueen M (1989) Management of distal radial fractures. J R Coll Surg Edinb 34(3):161

    PubMed  CAS  Google Scholar 

  4. Poigenfurst J (1980) Dislocations and dislocation fractures of the distal interphalangeal joints. Hefte Unfallheilkd 141:135–138

    PubMed  Google Scholar 

  5. 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(4):418–423

    PubMed  CAS  Google Scholar 

  6. Geissler WB (1995) Arthroscopically assisted reduction of intra-articular fractures of the distal radius. Hand Clin 11(1):19–29

    PubMed  CAS  Google Scholar 

  7. Dao KD, Solomon DJ, Shin AY, Puckett ML (2004) The efficacy of ultrasound in the evaluation of dynamic scapholunate ligamentous instability. J Bone Joint Surg Am 86(7):1473–1478

    PubMed  Google Scholar 

  8. Weiss AP, Akelman E, Lambiase R (1996) Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy. J Bone Joint Surg Am 78(3):348–356

    PubMed  CAS  Google Scholar 

  9. Geissler WB (2005) Intra-articular distal radius fractures: the role of arthroscopy? Hand Clin 21(3):407–416

    Article  PubMed  Google Scholar 

  10. 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(11):2334–2340

    Article  PubMed  Google Scholar 

  11. Gologan R, Ginter VM, Ising N et al (2012) Carpal lesions associated with dislocated fractures of the distal radius: a systematic screening of 104 fractures using preoperative CT and MRI. Unfallchirurg (Epub ahead of print)

  12. Geissler WB, Freeland AE, Savoie FH et al (1996) Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78(3):357–365

    PubMed  CAS  Google Scholar 

  13. Richards RS, Bennett JD, Roth JH, Milne K Jr (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 22(5):772–776

    Article  PubMed  CAS  Google Scholar 

  14. Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14(4):594–606

    Article  PubMed  CAS  Google Scholar 

  15. Edwards CC 2nd, Haraszti CJ, McGillivary GR, Gutow AP (2001) Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am 26(6):1036–1041

    Article  PubMed  Google Scholar 

  16. Auge WK 2nd, Velazquez PA (2000) The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy. Arthroscopy 16(8):830–835

    Article  PubMed  Google Scholar 

  17. Wolf JM, Dukas A, Pensak M (o J) Advances in wrist arthroscopy. J Am Acad Orthop Surg 20(11):725–734

    Article  Google Scholar 

  18. Cooney WP 3rd, Dobyns JH, Linscheid RL (1980) Complications of Colles‘ fractures. J Bone Joint Surg Am 62(4):613–619

    PubMed  Google Scholar 

  19. Gliatis JD, Plessas SJ, Davis TR (2000) Outcome of distal radial fractures in young adults. J Hand Surg Br 25(6):535–543

    PubMed  CAS  Google Scholar 

  20. Goldfarb CA, Yin Y, Gilula LA et al (2001) Wrist fractures: what the clinician wants to know. Radiology 219(1):11–28

    PubMed  CAS  Google Scholar 

  21. Koval KJ, Harrast JJ, Anglen JO, Weinstein JN (2008) Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence? J Bone Joint Surg Am 90(9):1855–1861

    Article  PubMed  Google Scholar 

  22. Dahlen HC, Franck WM, Sabauri G et al (2004) Incorrect classification of extra-articular distal radius fractures by conventional X-rays. Comparison between biplanar radiologic diagnostics and CT assessment of fracture morphology. Unfallchirurg 107(6):491–498

    Article  PubMed  CAS  Google Scholar 

  23. Fischer M, Denzler C, Sennwald G (1996) Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases. Swiss Surg 2(6):269–272

    PubMed  CAS  Google Scholar 

  24. Rappold G, Leixnering M, Pezzei C (2001) Carpal injuries associated with distal radius fractures. Diagnosis and therapy. Handchir Mikrochir Plast Chir 33(4):221–228

    Article  PubMed  CAS  Google Scholar 

  25. Rikli DA, Babst R, Jupiter JB et al (2007) Distal radius fractures: new concepts as basis for surgical treatment. Handchir Mikrochir Plast Chir 39(1):2–8

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 80809, München, Deutschland

    S. Deiler, S. Häberle, P. Quentmeier, P. Biberthaler & P. Ahrens

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  1. S. Deiler
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  2. S. Häberle
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  3. P. Quentmeier
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  4. P. Biberthaler
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Correspondence to S. Deiler.

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Deiler, S., Häberle, S., Quentmeier, P. et al. Arthroskopisch unterstützte Frakturversorgung am Handgelenk. Unfallchirurg 116, 305–310 (2013). https://doi.org/10.1007/s00113-012-2348-z

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  • DOI: https://doi.org/10.1007/s00113-012-2348-z

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