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Ligamentum scapholunare und dessen Begutachtung

Scapholunate ligament and its assessmentt

  • Begutachtung
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Differenzierung einer traumatischen von einer unfallunabhängigen Schädigung des Lig. scapholunare (SLL) stellt auch weiterhin eine Herausforderung an den Gutachter dar. Der Nachweis einer traumatischen Zerreißung gelingt zuverlässig bei gesichertem, adäquatem Unfallhergang und beim Vorliegen von Begleitverletzungen (weitere Band-Kapsel-Rupturen, knöcherne Verletzungen und/oder einem „bone bruise“). Schwierig gestaltet sich die Zusammenhangsbeurteilung bei unklaren Ereignisabläufen, einer damit verbundenen geringen Krafteinleitung und erst später aufgetretenen, klinischen Symptomen, die dann im Rahmen weiterer Diagnostik die SLL-Ruptur aufzeigen. Hierbei gilt es, nach konkurrierenden Ursachen (angeborene Aplasie des SLL, verschleißbedingter Bandaufbrauch oder weitere traumatische Ereignisse) zu fahnden, die dann aber auch mit Sicherheit nachzuweisen sind. Häufigste Ursache für die traumatische SLL-Ruptur ist der Sturz auf die Handfläche des nach vorn ausgestreckten Armes.

Abstract

The distinction between traumatic and accident-independent damage of the scapholunate ligament (SLL) continues to be a challenge to medical experts. The traumatic tearing of a SLL can reliably be proven when an accident has been adequately documented and concomitant injuries (other ligament capsule ruptures, bony injuries and/or a bone bruise) are present. This decision is difficult in cases of unclear accident mechanisms, low acting forces and later occurring clinical symptoms which then lead through further diagnostics to the discovery of a ruptured SLL. In these cases, it is necessary to search for competing causes (congenital aplasia of the SLL, wear-related ligament damage or other traumatic events), which themselves have to be proven with certainty. The most common cause of traumatic SLL rupture is a fall onto the palm of the hand with an outstretched arm.

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Correspondence to H. Hempfling.

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H. Hempfling und M. Wich geben an, dass kein Interessenkonflikt besteht.

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Die Autoren sind Mitglieder des wissenschaftlichen Beirats der Fachgesellschaft für interdisziplinäre medizinische Begutachtung (FGIMB).

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Hempfling, H., Wich, M. Ligamentum scapholunare und dessen Begutachtung. Trauma Berufskrankh 20, 278–284 (2018). https://doi.org/10.1007/s10039-018-0395-6

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