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Operative Versorgungsstrategien für Handverletzungen beim Polytrauma

Eine systematische Literaturübersicht

Operative strategies for hand injuries in multiple trauma

A systematic review of the literature

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Zusammenfassung

Fragestellung

Anhand der Ergebnisse einer Literaturrecherche sollten Empfehlungen zum Vorgehen bei Handverletzungen von polytraumatisierten Patienten abgeleitet werden.

Methodik

Literatur zu Handverletzungen beim Polytrauma und klinische Studien zu Versorgungsstrategien von Monoverletzungen der Hand wurden über eine systematische Literaturrecherche (Medline, Cochrane und Handsuchen) und Klassifikationen nach Evidenzgüte (Level 1–5 nach dem Oxford-Schema) zusammengetragen.

Ergebnisse

Die besonderen Erfordernisse der Behandlung von Handverletzungen beim Polytrauma liegen in der zielgerichteten Diagnostik, der differenzierten Indikationsstellung und dem Timing. Abhängig von der Art und dem Ausmaß der Schädigung bestehen wesentliche Unterschiede bezüglich einer primären oder sekundären operativen Versorgung.

Schlussfolgerung

Handverletzungen stellen bedeutsame Schädigungen dar, die zu Behandlungsbeginn aufgrund der vitalen Gefährdung des Verletzten häufig übersehen werden. Sie bedürfen jedoch wegen ihrer langfristig oft erheblichen Auswirkungen auf Funktion und Lebensqualität einer frühzeitigen, exakten Diagnostik und einer differenzierten Versorgungsstrategie.

Abstract

Objective

Hand injuries are not life threatening but crucial in multiple trauma because of their long-term functional results. The goal of this systematic review was to derive recommendations for diagnostic and treatment procedures from a systematic review of the literature.

Methods

Articles on hand injuries in multiple trauma and articles on clinical trails for isolated hand injuries were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).

Results

The special management of hand injuries in multiple trauma requires accurate diagnostic procedures, differentiated therapy strategies, and adequate timing. Depending on type and extent of the injury, there are substantial differences for primary or secondary operative treatment.

Conclusion

Hand injuries represent important lesions in multiple trauma. Due to the life-threatening situation they may be overlooked in the beginning of the treatment. Because of their long-term consequences for function and health-related quality of life, hand injuries require an early and accurate diagnosis and a differentiated treatment strategy.

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  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum, Düsseldorf

    M. Schädel-Höpfner

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Diakonie-Krankenhaus, Schwäbisch-Hall

    H. Siebert

  3. Klinik für Unfall- und Handchirurgie, Universitätsklinikum, Moorenstraße 5, 40225, Düsseldorf

    M. Schädel-Höpfner

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Schädel-Höpfner, M., Siebert, H. Operative Versorgungsstrategien für Handverletzungen beim Polytrauma. Unfallchirurg 108, 850–857 (2005). https://doi.org/10.1007/s00113-005-0996-y

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