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Therapie und Komplikationsmanagement bei Klavikulaschaftfrakturen

Treatment and complication management in midshaft clavicle fractures

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

In der Behandlung von Klavikulaschaftfrakturen vollzog sich ein grundlegender Wandel von der konservativen hin zur operativen Therapie. Die Frakturheilung ist langwierig, und die Behandlung ist komplikationsträchtig.

Komplikationsrisiko

In neueren Studien wurden unbefriedigende Ergebnisse nach konservativer Therapie dislozierter Frakturen nachgewiesen und Risikofaktoren für das Auftreten von Komplikationen identifiziert. Die knöcherne Konsolidierung unter Verkürzung der Klavikula oder die Pseudarthrosenbildung können eine operative Revision erforderlich machen. Die Patienten sind durch Implantatmaterial und zugangsbedingte Hypästhesien beeinträchtigt.

Ziel des Beitrags

Beschrieben werden die Diagnostik und Analyse von Klavikulafrakturen sowie die Therapieplanung. Typische Fehlerquellen werden benannt, die bei der primären Osteosynthese und bei Revisionseingriffen zum Therapieversagen führen können.

Therapie

Die konservative Behandlung ist heutzutage nur noch bei kaum und gar nicht dislozierten Frakturen der Standard. Dislozierte und mehrteilige Frakturen werden mit einer stabilen Plattenosteosynthese zur Ausheilung gebracht. Einfache Frakturen können mit einer elastischen Marknagelosteosynthese versorgt werden. Bei Pseudarthrosen kommt zusätzlich die Spongiosaplastik zum Einsatz, komplexe Infektverläufe mit großer Defektzone können hochspezialisierte Knochenersatzverfahren in Form einer gefäßgestielten Transplantation eines Fibulainterponats oder eines kortikoperiostalen Lappens notwendig machen.

Abstract

Background

Treatment of midshaft clavicle fractures underwent a fundamental change from nonoperative towards surgical therapy. The process of fracture consolidation is protracted and therapy is susceptible to complications.

Risk factors for complications

Recent studies provided evidence of poor results after nonoperative treatment of displaced fractures and identified risk factors for complications. The main complications leading to revision surgery are malunion with clavicle shortening and nonunion. Patients often complain about discomfort from implanted hardware and hypaesthesia due to the surgical approach.

Aim of this article

This article describes diagnostic steps and the classification of midshaft clavicle fractures as well as the planning of the therapeutic concept.

Treatment

Nonoperative treatment nowadays is considered the therapeutic standard for undisplaced fractures only. Displaced and multifragmentary fractures are treated by open reduction and internal plate fixation; simple fracture patterns can be fixed internally by elastic nails. Revision surgery of midshaft clavicle nonunion involves autologous spongiosa graft. Complex and chronic cases of osteitis with large bone defects may require specialized procedures such as free vascularized fibula grafts or corticoperiosteal bone graft.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. U. Rudolph, J. Fassbender, K. Schmidt-Horlohé, U. Schweigkofler und R. Hoffmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie und Orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland

    H.U. Rudolph, J. Fassbender, K. Schmidt-Horlohé, U. Schweigkofler & R. Hoffmann

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  1. H.U. Rudolph
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  2. J. Fassbender
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  3. K. Schmidt-Horlohé
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  4. U. Schweigkofler
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Correspondence to H.U. Rudolph.

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Rudolph, H., Fassbender, J., Schmidt-Horlohé, K. et al. Therapie und Komplikationsmanagement bei Klavikulaschaftfrakturen . Trauma Berufskrankh 16, 13–22 (2014). https://doi.org/10.1007/s10039-014-2069-3

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