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Radiusköpfchenfraktur und Ellenbogenluxation

Fracture of the radial head and elbow dislocation

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Radiusköpfchenfrakturen können isoliert oder als Begleitverletzung bei komplexen Verletzungsmustern des Ellenbogens auftreten; 10% der Ellenbogenluxationen sind mit einer Radiusköpfchenfraktur assoziiert. In der Diagnostik muss auf Begleitverletzungen geachtet werden, da sie das Therapieregime beeinflussen. Die Einteilung erfolgt nach Mason. Typ-1-Frakturen werden konservativ-frühfunktionell, Typ-2-Frakturen in der Regel mittels Schraubenosteosynthese versorgt. Die operative Rekonstruktion bei Mason-3-Frakturen ist schwierig und chirurgisch anspruchsvoll; hier muss, wie auch bei Typ-4-Frakturen, in der Regel das Radiusköpfchen reseziert werden. Liegt danach eine Gelenkinstabilität vor, ist die Implantation einer Radiusköpfchenprothese indiziert. Abhängig von der Schwere und Komplexität der Verletzung muss mit einem Funktionsverlust gerechnet werden. Neuere Studien zeigen gute Resultate nach Rekonstruktionen auch komplexerer Frakturen; häufig verbleibt ein funktionell unbedeutendes Streckdefizit. Auch die Resektion führt überwiegend zu guten bis akzeptablen funktionellen Ergebnisse. Obwohl Langzeitergebnisse bei den neueren modularen Radiusköpfchenprothesen noch ausstehen, wird in der Mehrzahl von guter Funktion bei niedrigen Lockerungsraten berichtet.

Abstract

Fractures of the radial head can occur isolated or in association with injuries to the elbow (10% of elbow dislocations being combined with fractures of the radial head). Attention to associated injuries is essential during the diagnostic investigations, as they influence the management significantly. These fractures are classified according to the system proposed by Mason. Mason type 1 fractures are managed with conservative and functional treatment. Mason type 2 fractures are treated surgically, normally by internal fixation with screws. The treatment of Mason type 3 or 4 fractures usually involves excision of the radial head. When instability persists after this, implantation of a prosthesis is recommended. Depending on the severity and complexity of the injury, some loss of function must be expected. Recent studies have recorded good results following reconstruction of the radial head, even in the case of comminuted fractures; any deficit remaining is often functionally insignificant. The excision of the radial head also results in good to acceptable outcomes. Although long-term results with the modular prosthesis are still lacking, in the majority of the studies so far good functional results with low rates of loosening have been observed.

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Zimmermann, G., Wagner, C., Moghaddam, A. et al. Radiusköpfchenfraktur und Ellenbogenluxation. Trauma Berufskrankh 6, 297–303 (2004). https://doi.org/10.1007/s10039-004-0962-x

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