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Klassifikation und Therapie von ellengelenknahen Verletzungen

Classification and therapy of fractures close to the elbow

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Bei den seltenen Frakturen und Luxationen in der Umgebung des Ellengelenks sind die frühe Diagnose und adäquate Therapie eminent wichtig. Die distalen Humerusfrakturen Typ B und C nach AO (Arbeitsgemeinschaft für Osteosynthesefragen) gehen gehäuft mit neurologischen Verletzungen einher und werden in der Regel osteosynthetisch versorgt. Auch die Klassifikation nach Schatzker, die das am besten geeignete Osteosyntheseverfahren berücksichtigt, findet bei Olekranonfrakturen Anwendung. Frakturen des Processus coronoideus sind sehr häufig mit Ellenbogenluxationen vergesellschaftet und werden nach Regan und Morrey eingeteilt. Sie werden je nach Frakturtyp und Stabilitätsgrad des Gelenks konservativ oder operativ behandelt. Radiusköpfchenfrakturen werden nach Mason eingeteilt. Die einfache Frakturform kann konservativ behandelt werden, dislozierte sowie Mehrfragmentfrakturen erfordern eine Osteosynthese oder eine partielle bzw. komplette Resektion. Bei Gelenkinstabilität nach Resektion kann eine Radiusköpfchenprothese notwendig werden. Gesondert wird auf Monteggia-, Essex-Lopresti- und „terrible triad“-Verletzungen eingegangen. Ein luxierter Ellenbogen muss rasch in Analgosedierung reponiert werden.

Abstract

Fractures and luxations in the range of the upper arm and forearm close to the elbow are rare in adults. The early diagnosis and correct therapy is very important to restore the function of the complex elbow joint. Distal humeral fractures AO type B and C often go along with neurological lesions. The therapy as a rule is open reduction and internal fixation. The most common classification of olecranon fractures is named after Schatzker. The classification considers the type of osteosynthesis, which is needed subject to the number of fracture fragments. Fractures of the processus coronoideus are often associated with luxation of the elbow and are classified according to Regan and Morrey. Depending on fracture type and level of stability of the elbow joint, conservative or operative therapy is recommended. The Mason classification is widely accepted for fractures of the radial head. The simple type of fracture is treated conservatively, while dislocated fractures and more fragmented fractures necessitate osteosynthesis or resection. In cases of joint instability after resection, a radial head prosthesis should be implanted. Separately the Monteggia injury, the Essex-Lopresti injury and “terrible triad” injury as severe combined lesions of the elbow joint are reviewed. All types of injuries are frequently under-diagnosed at first visitation and result in poor functional outcome. Luxation of the elbow joint requires a rapid reposition after analgesic sedation.

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Literatur

  1. Adams JE, Hoskin TL, Morrey BF, Steinmann SP (2009) Management and outcome of 103 acute fractures of the coronoid process of the ulna. J Bone Joint Surg Br 91:632–635

    Article  CAS  PubMed  Google Scholar 

  2. Ashwood N, Bain GI, Unni R (2004) Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. J Bone Joint Surg Am 86-A:274–280

    Google Scholar 

  3. Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50:71–86

    Article  CAS  PubMed  Google Scholar 

  4. Beingessner DM, Dunning CE, Gordon KD et al (2004) The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 86-A:1730–1739

    Google Scholar 

  5. Buvanendran A, Kroin JS, Berger RA (2007) Preoperative cyclooxygenase-2 inhibitor treatment reduces the incidence of heterotopic ossification after hip arthroplasty: six-month follow-up. Anesthesiology 107:358–359

    Article  PubMed  Google Scholar 

  6. Chalidis B, Dimitriou C, Papadopoulos P et al (2009) Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury 40:582–590

    Article  CAS  PubMed  Google Scholar 

  7. Chao ST, Joyce MJ, Suh JH (2007) Treatment of heterotopic ossification. Orthopedics 30:456–465

    Google Scholar 

  8. Clarke SE, Lee SY, Raphael JR (2009) Coronoid fixation using suture anchors. Hand (N Y) 4:156–160

  9. Cobb TK, Morrey BF (1995) Use of distraction arthroplasty in unstable fracture dislocations of the elbow. Clin Orthop Relat Res 312:201–210

    PubMed  Google Scholar 

  10. Cobb TK, Morrey BF (1997) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Am 79:826–832

    CAS  PubMed  Google Scholar 

  11. Deuel CR, Wolinsky P, Shepherd E, Hazelwood SJ (2007) The use of hinged external fixation to provide additional stabilization for fractures of the distal humerus. J Orthop Trauma 21:323–329

    Article  PubMed  Google Scholar 

  12. Edwards GS Jr, Jupiter JB (1988) Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. Clin Orthop Relat Res 234:61–69

    PubMed  Google Scholar 

  13. Frankle MA, Herscovici D Jr, DiPasquale TG et al (2003) A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 17:473–480

    Article  PubMed  Google Scholar 

  14. Gehr J, Friedl W (2006) Intramedullary locking compression nail for the treatment of an olecranon fracture. Oper Orthop Traumatol 18:199–213

    Article  PubMed  Google Scholar 

  15. Großstück R, Conrad T, Deml O et al (2008) Standards in der Endoprothetik nach Gelenkverletzungen. Trauma Berufskrankh 10:155–170

    Article  Google Scholar 

  16. Haasper C, Jagodzinski M, Krettek C, Zeichen J (2006) Hinged external fixation and closed reduction for distal humerus fracture. Arch Orthop Trauma Surg 126:188–191

    Article  PubMed  Google Scholar 

  17. Heim U (1998) Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year. Rev Chir Orthop Reparatrice Appar Mot 84:142–153

    CAS  PubMed  Google Scholar 

  18. Herbertsson P, Josefsson PO, Hasserius R et al (2004) Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am 86-A:1925–1930

    Google Scholar 

  19. Hoellen IP, Bauer G, Holbein O (1997) Prosthetic humeral head replacement in dislocated humerus multi-fragment fracture in the elderly – an alternative to minimal osteosynthesis? Zentralbl Chir 122:994–1001

    CAS  PubMed  Google Scholar 

  20. Holmenschlager F, Halm JP, Winckler S (2002) Fresh fractures of the radial head: results with the Judet prosthesis. Rev Chir Orthop Reparatrice Appar Mot 88:387–397

    CAS  PubMed  Google Scholar 

  21. Hotchkiss R (2000) Longitudinal instability of the forearm. From the 67th Annual Meeting of the American Academy of Orthopaedic Surgeons (ASSH), March 15–19, 2000, Orlando, FL

  22. Ikeda M, Yamashina Y, Kamimoto M, Oka Y (2003) Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J Bone Joint Surg Br 85:1040–1044

    Article  CAS  PubMed  Google Scholar 

  23. Ilahi OA, Strausser DW, Gabel GT (1998) Post-traumatic heterotopic ossification about the elbow. Orthopedics 21:265–268

    CAS  PubMed  Google Scholar 

  24. Johnson JA, Beingessner DM, Gordon KD et al (2005) Kinematics and stability of the fractured and implant-reconstructed radial head. J Shoulder Elbow Surg 14:195S–201S

    Article  PubMed  Google Scholar 

  25. King GJ, Evans DC, Kellam JF (1991) Open reduction and internal fixation of radial head fractures. J Orthop Trauma 5:21–28

    Article  CAS  PubMed  Google Scholar 

  26. Korner J, Lill H, Josten C (2002) Monteggiaverletzungen. In: Josten C, Lill H (Hrsg) Ellenbogenverletzungen. Steinkopff, Darmstadt, S 123–136

  27. Korner J, Diederichs G, Arzdorf M et al (2004) A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma 18:286–293

    Article  PubMed  Google Scholar 

  28. Korner J, Hoffmann A, Rudig L et al (2004) [Monteggia injuries in adults: critical analysis of injury pattern, management, and results.] Unfallchirurg 107:1026–1040

    Google Scholar 

  29. Koslowsky TC, Mader K, Dargel J et al (2009) Olecranon fracture fixation with a new implant: biomechanical and clinical considerations. Injury 40:618–624

    Article  PubMed  Google Scholar 

  30. Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42(172):123–132

    Article  CAS  PubMed  Google Scholar 

  31. McKee MD (2004) Surgical management of elbow dislocations associated with radial head and coronoid fractures: How to tame the „terrible triad“ of the elbow. Orthop Traumatol 3:238–252

    Google Scholar 

  32. McKee MD, Veillette CJ, Hall JA et al (2009) A multicenter, prospective, randomized, controlled trial of open reduction – internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 18:3–12

    Article  PubMed  Google Scholar 

  33. Mittlmeier T, Beck M (2009) [Articulated external fixator at the elbow.] Unfallchirurg 112:506–512

    Google Scholar 

  34. Morrey BF, Chao EY, Hui FC (1979) Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am 61:63–68

    CAS  PubMed  Google Scholar 

  35. Morrey BF, Tanaka S, An KN (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 265:187–195

    PubMed  Google Scholar 

  36. Muller LP, Kamineni S, Rommens PM, Morrey BF (2005) Primary total elbow replacement for fractures of the distal humerus. Oper Orthop Traumatol 17:119–142

    Article  PubMed  Google Scholar 

  37. Neuber M, Joist A, Joosten U, Rieger H (2000) [Late sequelae and treatment strategies of distal radio-ulnar dissociation after undetected Essex-Lopresti lesion.] Unfallchirurg 103:1093–1096

    Google Scholar 

  38. Regan W, Morrey BF (1992) Classification and treatment of coronoid process fractures. Orthopedics 15(7):845–848

    CAS  PubMed  Google Scholar 

  39. Schatzker J (1987) Olecranon fractures. In: Schatzker J, Tile M (eds) The rational basis of operative fracture care. Springer, Berlin Heidelberg New York

  40. Shao YC, Harwood P, Grotz MR et al (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 87:1647–1652

    Article  CAS  PubMed  Google Scholar 

  41. Wick M, Lies A, Muller EJ et al (1998) [Prostheses of the head of the radius. What outcome can be expected?] Unfallchirurg 101:817–821

  42. Winter M, Chuinard C, Cikes A et al (2009) Surgical management of elbow dislocation associated with non-reparable fractures of the radial head. Chir Main 28:158–167

    Article  CAS  PubMed  Google Scholar 

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  1. Sektion für Unfallchirurgie, Klinik für Chirurgie des Stütz- und Bewegungsapparates, Universitätsklinikum Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    A.C. Unger, F. Renken, J. Gille,  A.P. Schulz & C. Jürgens

  2. BG-Unfallkrankenhaus Hamburg, Hamburg, Deutschland

    A.P. Schulz, M. Faschingbauer & C. Jürgens

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  1. A.C. Unger
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  2. F. Renken
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  3. J. Gille
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  4. A.P. Schulz
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  5. M. Faschingbauer
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  6. C. Jürgens
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Correspondence to A.P. Schulz.

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Unger, A., Renken, F., Gille, J. et al. Klassifikation und Therapie von ellengelenknahen Verletzungen. Trauma Berufskrankh 12, 247–254 (2010). https://doi.org/10.1007/s10039-010-1693-9

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