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Die ossäre Bankart-Läsion

Bony Bankart lesions

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Zusammenfassung

Ein nicht unbedeutender Teil traumatischer vorderer Schultergelenksluxationen geht mit knöchernen Pfannenrandbeteiligungen, sog. ossären Bankart-Läsionen, einher. Das primäre Ziel ist die Wiedererlangung eines stabilen Schultergelenks mit guter Funktion. Dazu ist in der Regel eine nahezu anatomische Glenoidkontur Voraussetzung. Die Art des therapeutischen Eingriffs wird durch mehrere Faktoren beeinflusst. Insbesondere die Größe und Anzahl der Fragmente sowie die Gelenk- und Frakturstellung nach Reposition und auch patientenspezifische Faktoren wie das jeweilige Aktivitätsniveau sowie das Alter sind dabei relevant. Zudem sind das Alter der Fraktur sowie die vorangegangene Zahl der Luxationen von großer Bedeutung. Akute ossäre Bankart-Läsionen mit kleiner Fragmentgröße (< 15 % der Glenoidfläche) sind häufig gut konservativ zu therapieren, falls das Schultergelenk nach Reposition radiologisch zentriert steht. Demgegenüber ist bei größerem Frakturausmaß (> 15 %), sowie im Falle chronischer Instabilitäten, ein operatives Vorgehen zu empfehlen. Im Falle eines signifikanten Knochenverlusts sind meist anatomische (J-Span, Allografts) oder nichtanatomische (Latarjet, Bristow) Rekonstruktionsverfahren indiziert. Generell sollte aber das Risikoprofil eines jeden Patienten mit in die Entscheidung über weitere therapeutische Maßnahmen einfließen.

Abstract

Fractures of the anteroinferior glenoid rim, termed bony Bankart lesions, have been reported to occur in up to 22 % of first time anterior shoulder dislocations. The primary goal of treatment is to create a stable glenohumeral joint and a good shoulder function. Options for therapeutic intervention are largely dependent on the chronicity of the lesion, the activity level of the patient and postreduction fracture characteristics, such as the size, location and number of fracture fragments. Non-operative treatment can be successful for small, acute fractures, which are anatomically reduced after shoulder reduction. However, in patients with a high risk profile for recurrent instability initial Bankart repair is recommended. Additionally, bony fixation is recommended for acute fractures that involve more than 15–20 % of the inferior glenoid diameter. On the other hand chronic fractures are generally managed on a case-by-case basis depending on the amount of fragment resorption and bony erosion of the anterior glenoid with high recurrence rates under conservative therapy. When significant bone loss of the anterior glenoid is present, anatomical (e.g. iliac crest bone graft and osteoarticular allograft) or non-anatomical (e.g. Latarjet and Bristow) reconstruction of the anterior glenoid is often indicated.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Die Publikation dieses Artikels wurde nicht durch auswärtige Mittel unterstützt. U.J. Spiegl, S. Braun und S.A. Euter: Steadman and Philippon Research Scholars sponsored by Arthrex. S. Braun: Beratertätigkeit für die Fa. Arthrex. R.J. Warth gibt an, dass kein Interessenkonflikt besteht. P.J. Millett: Beratertätigkeit für die Fa. Arthrex und Myos Inc., Aktienbesitz GameReady, VuMedi, Steadman and Philippon Research Institute sponsored by Arthrex, Ossur, Smith & Nephew, Siemens. Es besteht allerdings kein Zusammenhang mit der Veröffentlichung dieses Artikels. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Steadman Philippon Research Institute, Suite 1000, 81657, Vail, CO, USA

    U.J. Spiegl MD, S.A. Euler MD, R.J. Warth MD & P.J. Millett MD, Msc

  2. The Steadman Clinic, Vail, CO, USA

    U.J. Spiegl MD, S.A. Euler MD & P.J. Millett MD, Msc

  3. Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Leipzig, Deutschland

    U.J. Spiegl MD

  4. Abteilung für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland

    S. Braun MD

  5. Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Innsbruck, Österreich

    S.A. Euler MD

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  1. U.J. Spiegl MD
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  2. S. Braun MD
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  3. S.A. Euler MD
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  4. R.J. Warth MD
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  5. P.J. Millett MD, Msc
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Correspondence to P.J. Millett MD, Msc.

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Spiegl, U., Braun, S., Euler, S. et al. Die ossäre Bankart-Läsion. Unfallchirurg 117, 1125–1140 (2014). https://doi.org/10.1007/s00113-014-2703-3

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