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Diagnostik und Therapie frischer Skaphoidfrakturen

Diagnostics and treatment of acute scaphoid fractures

Der Unfallchirurg volume 122, pages 182–190 (2019)Cite this article

Zusammenfassung

Hintergrund

Skaphoidfrakturen sind häufig, können in der nativen Projektionsradiographie leicht übersehen werden und führen, falls nicht oder nur unzureichend diagnostiziert und daher unsachgemäß behandelt, oft zu problematischen Heilverläufen mit Pseudarthrosenbildung und schmerzhafter Handgelenkarthrose.

Fragestellung

In dieser Übersichtsarbeit sollen praktische Handlungsempfehlungen zu Diagnostik und Behandlung von Skaphoidfrakturen ausgesprochen werden.

Material und Methode

Es fanden eine Analyse und Übersicht ausgewählter Literatur unter Einbeziehung der aktuellen S3-Leitlinie statt.

Ergebnisse

Hauptaussagen sind, dass bei klinischem Verdacht auf eine Skaphoidfraktur eine Stufendiagnostik mit Röntgen, Computertomographie (CT) und, falls nötig, Magnetresonanztomographie (MRT) bis zum sicheren Nachweis oder Ausschluss einer Verletzung durchgeführt werden sollte. Die Therapieplanung bei nachgewiesener Fraktur erfolgt anhand einer CT-basierten Klassifikation. Es gibt Frakturtypen, die dem Behandler die Wahl zwischen einer operativen und einer konservativen Therapie lassen, und Frakturtypen, die immer operiert werden sollten. Die Operationstechnik wird ebenfalls vom genauen morphologischen Frakturbefund vorgegeben. Zur Osteosynthese werden meist kopflose Doppelgewindeschrauben mit Kompressionseffekt benutzt.

Abstract

Background

Fractures of the scaphoid bone are common but can easily be overlooked in standard X‑rays. Inadequate diagnostics and therefore inappropriate treatment of scaphoid fractures often leads to problems in healing with formation of non-union and painful osteoarthritis of the wrist.

Objective

This review summarizes the current practical recommendations in the diagnostics and treatment of acute scaphoid fractures.

Methods

An analysis and review of selected literature including the current S3 guidelines were performed.

Results

The main statements are that in cases of a clinically suspected scaphoid fracture, staged diagnostics including radiographs, computed tomography (CT) and when necessary magnetic resonance imaging (MRI) should be applied to confirm or exclude a fracture. Further treatment in the case of a fracture is planned according to a CT-based classification. There are fracture types that can be treated either conservatively or operatively and there are other fracture types that always require operative fixation. The operative technique depends on the exact fracture geometry. For osteosynthesis, cannulated headless compression screws are mostly used.

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Authors and Affiliations

  1. Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie, BG Unfallklinik Frankfurt, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland

    F. Neubrech, A. Terzis, J. Seegmüller & M. Sauerbier

Authors
  1. F. Neubrech
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  2. A. Terzis
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  3. J. Seegmüller
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  4. M. Sauerbier
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Corresponding author

Correspondence to F. Neubrech.

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Interessenkonflikt

F. Neubrech, A. Terzis und J. Seegmüller geben an, dass kein Interessenkonflikt besteht. M. Sauerbier verfügt über einen Berater- und Entwicklungsvertrag mit der Fa. Medartis AG, Basel, Schweiz.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Schädel-Höpfner, Neuss

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Neubrech, F., Terzis, A., Seegmüller, J. et al. Diagnostik und Therapie frischer Skaphoidfrakturen. Unfallchirurg 122, 182–190 (2019). https://doi.org/10.1007/s00113-018-0588-2

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  • DOI: https://doi.org/10.1007/s00113-018-0588-2

Schlüsselwörter

  • Diagnostische Bildgebung
  • Knochenschrauben
  • Frakturfixation
  • Konservative Behandlung
  • Frakturheilung

Keywords

  • Diagnostic imaging
  • Bone screws
  • Fracture fixation
  • Conservative treatment
  • Fracture healing