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Destruktion des Radiuskopfes

Endoprothese, autologer Aufbau oder Anconeusplastik?

Destruction of the radial head

Endoprosthesis, autologous reconstruction or anconeus arthroplasty?

Zusammenfassung

Hintergrund

Knorpelschäden und Defektzustände der radialen Säule des Ellenbogens sind meist die Folge eines Traumas. Aufgrund des meist jungen Alters der Patienten und des hohen funktionellen Anspruchs mit schweren Gewichtsbelastungen gilt es, endoprothetische Optionen weitestmöglich hinauszuzögern. Sind konservative Maßnahmen nicht mehr ausreichend, stehen radiuskopferhaltende, resezierende und endoprothetische Optionen zur Auswahl. In früheren Stadien der radiocapitellaren Gelenkschädigung kommen kopferhaltende Maßnahmen in Betracht. Mit zunehmender Knorpelschädigung sinkt die Chance auf ein zufriedenstellendes Ergebnis.

Therapeutische Optionen

Der vorliegende Artikel diskutiert neben den kopferhaltenden Maßnahmen auch die Radiuskopfresektion mit oder ohne Anconeusinterposition sowie die Radiuskopfprothese und den radiocapitellaren Ersatz. Die Datenlage ist schwach. Die Vor- und Nachteile der verschiedenen Optionen müssen offen mit den Patienten diskutiert und die Therapieentscheidung individuell gemäß patientenspezifischer Faktoren getroffen werden. Ziel der chirurgischen Therapie muss es sein, die endoprothetische Versorgung – v. a. die Totalendoprothese – soweit wie möglich hinauszuzögern und dabei einen funktionellen Bewegungsumfang bei akzeptablen Schmerzen zu gewährleisten.

Abstract

Background

Radiocapitellar arthritis or defects most often result from trauma. Most of the patients are young and have high functional demands with high load capacities. Therefore, endoprosthetic options should be postponed for as long as possible. If conservative treatment cannot relieve symptoms sufficiently, radial head preservation, resection or replacement options are at the surgeon’s disposal. In early stages of radiocapitellar arthritis, radial head preservation options can be taken into account. The chances ofgood results decrease with increasing cartilage damage.

Treatment options

In addition to radial head preservation options this article discusses radial head resection with and without anconeus interposition and radial head as well as radiocapitellar replacement. Clinical data are rare. The advantages and disadvantages of each option must be discussed with the patient and the decision should be made individually on the basis of patient specific factors. The aim must be to postpone endoprosthetic options – especially total elbow arthroplasty – for as long as possible, while assuring a functional range of motion with an acceptable pain level.

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Abbreviations

ASK:

Arthroskopie

IBP:

Instrumented Bone Preserving

LCL:

Laterales Kollateralband

MCL:

Mediales Kollateralband

MEPS:

Mayo Elbow Performance Score

PE:

Polyethylen

PLRI:

Posterolaterale Rotationsinstabilität

TEP:

Totalendoprothese

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Correspondence to K. J. Burkhart.

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Interessenkonflikt

K. J. Burkhart, F. Gohlke, R. Nietschke, M. M. Schneider und B. Hollinger geben an, dass kein Interessenkonflikt besteht.

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

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Burkhart, K.J., Gohlke, F., Nietschke, R. et al. Destruktion des Radiuskopfes. Orthopäde 46, 981–989 (2017). https://doi.org/10.1007/s00132-017-3492-5

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Schlüsselwörter

  • Ellenbogen
  • Gelenkersatz
  • Knorpel
  • Radius
  • Trauma

Keywords

  • Elbow
  • Joint replacement
  • Cartilage
  • Radius
  • Trauma