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Die okkulte Skaphoidfraktur: aktuelle Evidenz und diagnostischer Algorithmus

Occult scaphoid fractures: current evidence and diagnostic algorithm

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Zusammenfassung

Skaphoidfrakturen sind häufig, werden in 20–40 % der Fälle aber übersehen. Bei sog. okkulten Skaphoidfrakturen – klinische Skaphoidfrakturen mit negativer Röntgendiagnostik – wird traditionell und empirisch die Hand des Patienten in einem Gips ruhiggestellt und die Röntgendiagnostik nach 10 Tagen wiederholt. Anhand der aktuellen Literatur wird in diesem Artikel ein Diagnostikalgorithmus vorgestellt, welcher verschiedene Patientenkonstellationen und auch sozioökonomische Aspekte miteinbezieht und eine mögliche Nachbehandlung vorschlägt.

Bei arbeitstätigen Patienten kann eine frühzeitige weiterführende Diagnostik medizinisch und sozioökonomisch sinnvoll sein, wobei bei Rentnern und Patienten mit geringem manuellen Anspruch der traditionelle Algorithmus gerechtfertigt ist. Ob eine Computertomographie(CT)‑ oder Magnetresonanztomographie(MRT)-Diagnostik mit oder ohne intraartikuläres Kontrastmittel gewählt wird, sollte u. a. von einer klinisch vermuteten, zusätzlichen Weichteilverletzung abhängig gemacht werden.

Abstract

Scaphoid fractures are frequent but are overlooked in 20–40% of cases on initial radiographs. In so-called occult scaphoid fractures, i.e. clinical scaphoid fractures with negative X‑ray diagnostics, the hand of the patient is often empirically immobilized with a cast and the X‑ray diagnostics repeated 10 days later. Based on the current literature the authors propose a diagnostic algorithm that incorporates various patient characteristics and socioeconomic aspects and suggests a possible follow-up treatment. For high-demand and manually working patients, timely advanced diagnostic imaging may be medically and socioeconomically meaningful. Pensioners and patients with low manual demands, however, can be treated according to the traditional algorithm. Additional use of computed tomography (CT) or magnetic resonance imaging (MRI) diagnostics with or without intra-articular contrast agent might be helpful if concomitant soft tissue injuries are suspected.

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Authors and Affiliations

  1. Orthopädie und Traumatologie, Bürgerspital Solothurn, 4500, Solothurn, Schweiz

    Andreas Flury

  2. Handchirurgie, Orthopädie und Traumatologie, Bürgerspital Solothurn, 4500, Solothurn, Schweiz

    Sebastian Günkel

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  1. Andreas Flury
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Correspondence to Andreas Flury.

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Interessenkonflikt

A. Flury und S. Günkel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Flury, A., Günkel, S. Die okkulte Skaphoidfraktur: aktuelle Evidenz und diagnostischer Algorithmus. Unfallchirurg 123, 238–243 (2020). https://doi.org/10.1007/s00113-019-00722-4

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  • DOI: https://doi.org/10.1007/s00113-019-00722-4

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