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Bedeutung des Ellengriffels bei der Behandlung distaler Radiusfrakturen

Significance of the styloid process of the ulna in treatment of distal fractures of the radius

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Fraktur des Processus styloideus ulnae (PSU, Ellengriffel) ist die häufigste Begleitverletzung der distalen Radiusfraktur. Sie ist meist asymptomatisch, eine beschwerdefreie und gute funktionelle Handgelenkbeweglichkeit ist allerdings nur bei stellungsgerechter Ausheilung der distalen Radiusfraktur zu erwarten. Zur Diagnose wird standardmäßig eine Röntgenaufnahme des Handgelenks in 2 Ebenen durchgeführt. Um Begleitverletzungen auszuschließen, sollten Röntgenspezialaufnahmen (nach Moneim und nach Stecher) angefertigt werden. Die zuverlässigste Aussage über eine knöcherne Beteiligung der Handwurzel oder Dislokation einer Fraktur gibt das CT. Das MRT kann zur Beurteilung ligamentärer Verletzungen eingesetzt werden. Eine Ruptur des triangulären fibrokartilaginären Komplexes und eine posttraumatische dynamische Instabilität können nur durch eine Handgelenkspiegelung bewiesen werden. Eine operative Versorgung sollte bei basisnaher Fraktur des PSU erfolgen, wenn nach Reposition und Stabilisierung der distalen Radiusfraktur das distale Radioulnargelenk bei der intraoperativen klinischen Untersuchung instabil erscheint oder der basisnah abgerissene PSU trotz Reposition auf dem Röntgenbild disloziert bleibt (mehr als 2 mm).

Abstract

Fracture of the styloid process of the ulna (processus styloideus ulnae; PSU) is the injury that is most often found in association with a distal fracture of the radius. It usually does not cause any symptoms, but good functional wrist mobility with no problems cannot be expected unless the distal radius fracture heals with the extremity in the correct position. The standard procedure used for diagnosis is X-ray examination of the wrist in two planes. To exclude concomitant injuries, special X-ray exposures (as recommended by Moneim and by Stecher) should be done. The most reliable information on bony involvement of the heel of the hand or dislocation of a fracture is yielded by CT. MRI can be used to assess injuries to the ligaments. Rupture of the triangular fibrocartilaginous complex and posttraumatic dynamic instability cannot be documented except by arthroscopic examination of the wrist. Operative treatment is indicated for a fracture close to the base of the PSU when, after re-alignment and stabilisation of the distal fracture of the radius, the distal radioulnar joint appears to be unstable on clinical examination during surgery or the PSU avulsed close to the base is still seen on the X-ray to be dislocated (more than 2 mm) despite re-alignment.

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Luther, C., Germann, G., Krimmer, H. et al. Bedeutung des Ellengriffels bei der Behandlung distaler Radiusfrakturen. Trauma Berufskrankh 9, 31–37 (2007). https://doi.org/10.1007/s10039-007-1211-x

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