Zusammenfassung
Hintergrund
Pro Jahr erleiden 3,1 % der erwachsenen Deutschen beim Sport einen Unfall; 75 % der Verletzten sind männliche Sportler mit einem Alter von 20–29 Jahren. Die obere Extremität ist in knapp über 20 % der Fälle betroffen. Ein Drittel dieser Verletzungen betreffen die Hand und die Finger.
Fragestellung
In Deutschland sind über eine halbe Million Sportler, mit steigender Tendenz, in Kampfsportverbänden organisiert. Kampfsportarten wird gemeinhin eine hohe Verletzungsgefahr für die Hand zugesprochen. Ziele dieser Arbeit waren die Überprüfung dieser Hypothese sowie die Beschreibung der typischen kampfsportassoziierten Handverletzungen.
Material und Methoden
Systematische Literaturrecherche (bis Januar 2015) in PubMed/Medline und der Cochrane Library sowie Ermittlung von Sekundärliteratur über die Literaturverzeichnisse.
Schlussfolgerung
Aussagekräftige vergleichende Studien zu Häufigkeit und Schwere von Handverletzungen, welche isoliert auf Kampfsporthandlungen zurückzuführen sind, können der aktuellen Literatur nicht entnommen werden. Das allgemeine Risiko für Sportverletzungen scheint beim Kampfsport im Vergleich zu anderen Sportarten eher gering zu sein. Boxen scheint für die obere Extremität und speziell die Hand aber die gefährlichste Sportart zu sein. Das Verletzungsmuster nach Faustschlägen (Notfallpatienten und Profiboxer) zeigt, dass über die Hälfte der schlaginduzierten Frakturen den 5. Mittelhandknochen betreffen, davon liegt in 25 % der Fälle die klassische „boxer’s fracture“ vor. Dies weicht deutlich von der Frakturverteilung nach allgemeinen sportassoziierten Handfrakturen ab, wo die Phalangen am Häufigsten betroffen sind. Zwei seltenere Krankheitsbilder, die als Folge wiederholter Faustschläge auftreten können, werden als „carpal bossing“ und „boxer’s knuckle“ bezeichnet. Bei beiden Krankheitsbildern sind exzellente Ergebnisse nach operativer Therapie beschrieben.
Abstract
Background
Each year 3.1 % of German adults suffer from accidents related to sports and 75 % of the injured athletes are male between 20 and 29 years old. The upper limbs are affected in more than 20 % of cases and one third of these injuries involve the hands and fingers.
Objectives
More than half a million athletes are organized in combat sport associations in Germany with an increasing trend. Combat sports are commonly said to have a high risk of injuries to the hand. The aim of this study was to test this hypothesis as well as to describe typical hand injuries associated with combat sports.
Material and methods
A systematic review of literature (up to January 2015) in PubMed/Medline and The Cochrane Library as well as a secondary search in the reference lists were carried out.
Conclusion
Conclusive comparative studies on the incidence and severity of hand injuries directly related to combat sports action could not be found in the currently available literature. The overall risk of suffering from a sports injury seems to be relatively low in combat sports compared to other sports. Boxing, however, seems to be the most dangerous sport for injuries to the upper extremities and especially the hand. The injury pattern after punching (emergency patients and professional boxers) shows that more than half of these fractures affect the 5th metacarpal and 25 % of these are the classical boxer’s fracture. This differs significantly from the fracture distribution generally associated with sports, where fractures of the phalanges are the most common. Two rare conditions that may occur as a result of repeated punching are referred to as carpal bossing and boxer’s knuckle and excellent results are described for both injury forms after surgical therapy.
Literatur
Aitken S, Court-Brown CM (2008) The epidemiology of sports-related fractures of the hand. Injury. doi:10.1016/j.injury.2008.04.012
Allenbach R, Hubacher M, Mathys R (1997) Sportunfalle und Verletzungsfolgen. Orthopade 26:916–919
Arai K, Toh S, Nakahara K et al (2002) Treatment of soft tissue injuries to the dorsum of the metacarpophalangeal joint (Boxer’s knuckle). J Hand Surg Br 27:90–95
Bledsoe GH, Hsu EB, Grabowski JG, Brill JD (2006) Incidence of injury in professional mixed martial arts competitions. J Sport Sci Med 5:136–142
Conway WF, Destouet JM, Gilula LA et al (1985) The carpal boss: an overview of radiographic evaluation. Radiology 156:29–31
Cuono CB, Watson HK (1979) The carpal boss: surgical treatment and etiological considerations. Plast Reconstr Surg 63:88–93
Deutscher Olympischer Sportband (2014) Bestandserhebung 2014
Fiolle J (1931) Le „carpe bossu.“ Bull Mémoires la Soc Natl Chir 57:1687–1690
Foucher G, Chemorin C, Sibilly A (1976) [A new technic of osteosynthesis in fractures of the distal 3rd of the 5th metacarpus]. Nouv Presse Med 5:1139–1140
Fusi S, Watson H, Cuono C (1995) The carpal bossA 20-year review of operative management. J Hand Surg J Br Soc Surg Hand 20:405–408
Gartland S, Malik MH, Lovell ME (2001) Injury and injury rates in Muay Thai kick boxing. Br J Sports Med 35:308–313
Gladden JR (1957) Boxer’s knuckle; a preliminary report. Am J Surg 93:388–397
Hölling H, Schmitz R, Butschalowski H et al (2014) Die Gesundheit von Kindern und Jugendlichen in Deutschland – 2013 (KIGGS1)
Hunter JM, Cowen NJ (1970) Fifth metacarpal fractures in a compensation clinic population. A report on one hundred and thirty-three cases. J Bone Joint Surg Am 52:1159–1165
Jeanmonod RK, Jeanmonod D, Damewood S et al (2011) Punch injuries: insights into intentional closed fist injuries. West J Emerg Med 12:6–10
Majewski M, Bewegungsapparat B (2010) Epidemiologie der Sportunfälle. Schweizerische Zeitschrift für Sport und Sport 58:38–42
McMahon PJ, Woods DA, Burge PD (1994) Initial treatment of closed metacarpal fractures. A controlled comparison of compression glove and splintage. J Hand Surg Br 19:597–600
McNemar TB, Howell JW, Chang E (2003) Management of metacarpal fractures. J Hand Ther 16:143–151
Meals C, Meals R (2013) Hand fractures: a review of current treatment strategies. J Hand Surg Am 38:1021–1031. (quiz 1031)
Melone CP, Polatsch DB, Beldner S (2009) Disabling hand injuries in boxing: boxer’s knuckle and traumatic carpal boss. Clin Sports Med 28:609–621, vii
Nagaoka M, Satoh T, Nagao S, Matsuzaki H (2006) Extensor retinaculum graft for chronic boxer’s knuckle. J Hand Surg Am 31:947–951
Nazarian N, Page RS, Hoy GA et al (2014) Combined joint fusion for index and middle carpometacarpal instability in elite boxers. J Hand Surg Eur 39:242–248
Noble C (1987) Hand injuries in boxing. Am J Sports Med 15:342–346
Pappas E (2007) Boxing, wrestling, and martial arts related injuries treated in emergency departments in the United States, 2002–2005. J Sport Sci Med 6:58–61
Park MJ, Namdari S, Weiss A-P (2008) The carpal boss: review of diagnosis and treatment. J Hand Surg Am 33:446–449
Poolman RW, Goslings JC, Lee JB et al (2005) Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane database Syst Rev (3):CD003210
Posner MA, Ambrose L (1989) Boxer’s knuckle–dorsal capsular rupture of the metacarpophalangeal joint of a finger. J Hand Surg Am 14:229–236
Prokop A, Kulus S, Helling HJ et al (1999) [Are there guidelines for treatment of metacarpal fractures? Personal results and literature analysis of the last 12 years]. Unfallchirurg 102:50–58
Schneider S, Seither B, Tönges S, Schmitt H (2006) Sports injuries: population based representative data on incidence, diagnosis, sequelae, and high risk groups. Br J Sports Med 40:334–339. (discussion 339)
Sletten IN, Hellund JC, Olsen B et al (2015) Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients. J Hand Surg Eur 40:76–83
Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP (2003) Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg 123:534–537
Steinbrück K (1999) [Epidemiology of sports injuries–25-year-analysis of sports orthopedic-traumatologic ambulatory care]. Sportverletz Sportschaden 13:38–52
Towfigh H (2011) Handchirurgie. Springer, Heidelberg
Tsuge K (1990) Atlas der Handchirurgie. Hippokrates, Stuttgart
Walrod B (2011) Current review of injuries sustained in mixed martial arts competition. Curr Sports Med Rep 10:288–289
Windolf J, Rueger JM, Werber KD et al (2009) [Treatment of metacarpal fractures. Recommendations of the Hand Surgery Group of the German Trauma Society]. Unfallchirurg 112:577–588
Winter M, Balaguer T, Bessière C et al (2007) Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur 32:709–713
Zazryn TR, Finch CF, McCrory P (2003) A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. Br J Sports Med 37:448–451
Zetaruk MN, Violán MA, Zurakowski D, Micheli LJ (2005) Injuries in martial arts: a comparison of five styles. Br J Sports Med 39:29–33
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
W.A. Hanna und P. Laier geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Additional information
Redaktion
M. Schädel-Höpfner, Neuss
Rights and permissions
About this article
Cite this article
Hanna, W., Laier, P. Verletzungen der Hand durch Kampfsport. Unfallchirurg 118, 507–514 (2015). https://doi.org/10.1007/s00113-015-0014-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00113-015-0014-y