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Komplexes Ellenbogentrauma: Therapie und Zugangswahl bei Terrible-triad-Verletzungen und Monteggia-like-Läsionen

Treatment of terrible triad injuries and Monteggia-like lesions: indications, surgical technique, and outcomes

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Zusammenfassung

Die Kombination aus einer humeroulnaren Ellenbogengelenkluxation mit Zerreißung von Teilen der Kapsel-Band-Strukturen sowie assoziierter Radiuskopf- und Koronoidfraktur wird als Terrible-triad-Verletzung bezeichnet. Die Monteggia-like-Läsion ist definiert als Fraktur der proximalen Ulna mit Luxation oder Luxationsfraktur des proximalen Radius aus dem proximalen Radioulnargelenk. Beide Luxationsfrakturen zählen zu den komplexen Luxationsformen des Ellenbogens und stellen aufgrund ihrer Verletzungsmuster eine besondere Herausforderung in der Behandlung dar. Ohne eine dezidierte Analyse des Verletzungsmusters und einen darauf abgestimmten Behandlungsalgorithmus können diese Frakturtypen mit einer hohen Rate an Komplikationen und anhaltenden Funktionseinschränkungen einhergehen. Übersehene oder falsch eingeschätzte Instabilitäten des Ellenbogengelenks können zu chronischen Luxations- und Subluxationsstellungen führen, die zu dauerhaften Schmerzen, Arthrosen und Bewegungseinschränkungen führen können. Ausgewählte Luxationsfrakturen ohne Instabilität im Ellenbogengelenk können in Einzelfällen konservativ behandelt werden. Die meisten Frakturtypen werden jedoch operativ behandelt. Für den Therapieerfolg ist es entscheidend, den luxierten und frakturierten Ellenbogen in ein stabil geführtes, zentriertes Gelenk zu überführen. Dies erfordert, falls nötig, die Rekonstruktion sowohl der knöchernen als auch der ligamentären und muskulären Stabilisatoren des Ellenbogengelenks. Dieser Artikel fasst die wesentlichen Hintergründe und Behandlungsstrategien der Terrible-triad-Verletzung und der Monteggia-like-Läsion zusammen und setzt sie in den aktuellen wissenschaftlichen Kontext.

Abstract

The combination of a humeroulnar dislocation of the elbow joint with disruption of parts of the capsuloligamentous structures along with an associated radial head and coronoid fracture is defined as a terrible triad injury. The term “Monteggia-like lesion” or “Monteggia-equivalent injury” encompasses fractures of the proximal ulna with dislocation and fracture of the radial head. Both injuries pose a particular challenge in treatment due to their specific and complex injury patterns. Incorrectly assessed instabilities of the elbow joint can lead to chronic dislocation and subluxation of the elbow, resulting in persistent pain, osteoarthritis, and poor functional outcomes. Selected fracture dislocations without instability of the elbow joint can be treated conservatively, but most fracture types require surgery. The aim of surgical therapy in managing these fracture patterns is restoration of the stability of the elbow joint. This can require reconstruction of the bony and ligamentous as well as muscular stabilizers of the elbow joint. This article discusses the important osseous and soft tissue stabilizers of the elbow joint and provides management protocols for the different injury patterns of the terrible triad injury and Monteggia-like lesions, and puts them into an up-to-date scientific context.

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Authors and Affiliations

  1. KSA Spital Zofingen, Zofingen, Schweiz

    J. N. Rippke

  2. Universitätsklinikum Essen, Essen, Deutschland

    B. Mester

  3. ARCUS Klinken, Pforzheim, Deutschland

    K. J. Burkhart

  4. Medizinische Fakultät, Universität zu Köln, Köln, Deutschland

    K. J. Burkhart

  5. KSA Kantonsspital Aarau, Aarau, Schweiz

    R. Glaab

  6. Unfallchirurgie und Orthopädie, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland

    S. Lotzien & M. Königshausen

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  1. S. Lotzien
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Correspondence to S. Lotzien.

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Interessenkonflikt

S. Lotzien, J.N. Rippke, B. Mester, K.J. Burkhart, R. Glaab und M. Königshausen geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

Die Autoren J.N. Rippke und S. Lotzien haben zu gleichen Teilen zum Manuskript beigetragen.

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Lotzien, S., Rippke, J.N., Mester, B. et al. Komplexes Ellenbogentrauma: Therapie und Zugangswahl bei Terrible-triad-Verletzungen und Monteggia-like-Läsionen. Obere Extremität (2024). https://doi.org/10.1007/s11678-024-00794-8

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