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Behandlung von Radiuskopffrakturen – Literaturübersicht

Treatment of radial head fractures—literature overview

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Zusammenfassung

Der Radiuskopf ist ein wichtiger Stabilisator des Ellenbogengelenks. Verletzungen des Radiuskopfes sind nicht selten mit weiteren destabilisierenden Begleitverletzungen vergesellschaftet und können zu relevanten funktionellen Einschränkungen des Ellenbogengelenks führen. Abhängig von der Verletzungsmorphologie muss eine differenzierte Therapie erfolgen. Nicht- oder gering dislozierte Frakturen können in den meisten Fällen konservativ behandelt werden. Dislozierte Frakturen werden in der Regel operativ versorgt. Die Rekonstruktion des Radiuskopfes erfolgt mittels Schrauben- und/oder Plattenosteosynthese. Zuletzt hat die technische Weiterentwicklung der Implantate das Indikationsspektrum für die Radiuskopfosteosynthese erweitert. Bei den nicht rekonstruierbaren Frakturen ist die Implantation einer Radiuskopfprothese die Therapie der Wahl. Gerade bei höhergradigen Verletzungen ist die Mitversorgung von osteoligamentären Begleitverletzungen essentiell, um ein gutes Therapieergebnis zu erzielen. Insgesamt ist die Evidenzlage zur Versorgung der Radiuskopffrakturen weiterhin unzureichend. Dies betrifft insbesondere die dislozierten und mehrfragmentären Brüche. Geringe Fallzahlen und ein meist retrospektives Studiendesign sind hierfür maßgeblich verantwortlich. Hinsichtlich eines im Durchschnitt jungen Patientenkollektivs stehen Langzeitergebnisse insbesondere zur Radiuskopfprothese noch aus. Entscheidend für eine erfolgreiche Behandlung der Radiuskopffrakturen ist die Wiederherstellung einer stabilen, stufenfreien Gelenkführung am humeroradialen Gelenk, sodass eine frühfunktionelle Beübung erfolgen kann und das Risiko für sekundäre degenerative Veränderungen minimiert wird.

Abstract

The radial head is an important stabilizer of the elbow joint. Radial head fractures are often associated with other destabilizing concomitant injuries and can lead to relevant functional limitations of the elbow. Depending on the injury a differentiated treatment regimen must be chosen. Non- or slightly displaced fractures can be treated conservatively in most cases. Displaced fractures are usually treated surgically. Anatomic fixation of the head fragments can be achieved by use of screws and/or plates. In recent years, technical progress has enhanced the indication for radial head osteosynthesis. In the case of non-reconstructable fractures the implantation of a radial head prosthesis is the treatment of choice. Especially with more complex fractures the treatment of associated osteoligamentous injuries is essential for a good outcome. Overall the evidence for the treatment of radial head fractures is insufficient especially for displaced and multifragmentary injuries. Low case numbers and retrospective study designs are responsible for that. Furthermore, long-term results are often missing in particular for radial head replacement. Successful treatment of radial head fractures requires anatomic reduction and stable fixation of the articular surface, allowing early active motion and minimizing the risk of secondary degenerative changes.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismanigerstr. 22, 81675, München, Deutschland

    Arne Buchholz

  2. Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismanigerstr. 22, 81675, München, Deutschland

    Sebastian Siebenlist

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  1. Arne Buchholz
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A. Buchholz und S. Siebenlist geben an, dass kein Interessenkonflikt besteht.

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Buchholz, A., Siebenlist, S. Behandlung von Radiuskopffrakturen – Literaturübersicht. Obere Extremität 14, 39–47 (2019). https://doi.org/10.1007/s11678-019-0503-7

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