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Endoprothesenversorgung nach Radiusköpfchentrümmerfrakturen

Mittelfristige Ergebnisse

Prosthesis after comminuted radial head fractures

Midterm results

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Zusammenfassung

Hintergrund

Radiusköpfchentrümmerfrakturen sind häufig mit Begleitverletzungen vergesellschaftet, die zu einer Beeinträchtigung der Ellenbogenfunktion und -stabilität führen können. Prothesen neuerer Generation sollen eine Verbesserung der Ergebnisse liefern. Ziel dieser Studie war es, die Ergebnisse der modularen EVOLVE®-Prothese zu evaluieren.

Patienten und Methoden

Von Juni 2001 bis Januar 2005 wurde bei 30 Patienten mit komplexen Radiusköpfchenfrakturen eine Prothese implantiert; 28 Patienten wurden nachuntersucht. Die mittlere Nachuntersuchungszeit betrug 29 Monate. Insgesamt lag 7-mal (25%) eine Mason-III- und 21-mal (75%) eine Mason-IV-Fraktur vor.

Ergebnisse

Nach den Kriterien des Morrey-Scores wurden 19 Patienten mit sehr gut und gut beurteilt, 8 Patienten wurden mit ausreichend eingestuft und 1 Ergebnis wurde als mangelhaft bewertet. Es wurde keine Instabilität des Ellenbogengelenks festgestellt.

Schlussfolgerung

Radiusköpfchentrümmerfrakturen mit ligamentären Begleitverletzungen können durch die primäre Radiusköpfchenprothese und ligamentäre Rekonstruktion mit einem guten funktionellen Ergebnis behandelt werden. Langzeitergebnisse sind zwar noch nicht verfügbar; aus mittelfristiger Sicht ist dies eine effektive Methode zur Wiederherstellung der Gelenkgeometrie bei einer übungsstabilen Versorgung des Ellenbogengelenks.

Abstract

Background

For many years, resection was the only therapy used for comminuted fractures of the radial head. When associated with an injury of the collateral ligament, the outcome was often unsatisfactory. Implantation of the modern radial head prosthesis promises a better outcome.

Methods

Between June 2001 and January 2005, 30 patients were treated with a modular metallic radial head arthroplasty; 28 patients were available for follow-up. Their mean age was 49 years. The patients were followed for an average of 29 months. The outcomes were assessed on the basis of pain, motion, radiographic findings, and grip strength as measured with the Jamar Dynamometer. The overall outcome was rated using a pain visual analog scale, and the scoring systems described by Radin and Riseborough and by Broberg and Morrey.

Results

19 patients achieved excellent or good results, 8 had fair results, and 1 had a poor result as based on the Morrey score. 22 patients showed periprosthetic osteolysis on radiologic examination.

Conclusion

Arthroplasty with a modular metallic radial head combined with ligament reconstruction is an effective alternative to radial head resection. Compared with resection, the results using the EVOLVE® prosthesis demonstrate definite advantages with regard to clinical outcome.

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Ludwigshafen Klinik für Orthopädie und Unfallchirurgie, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    A. Moghaddam, A. Lennert, S. Studier-Fischer, A. Wentzensen & G. Zimmermann

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  1. A. Moghaddam
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  2. A. Lennert
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  3. S. Studier-Fischer
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  4. A. Wentzensen
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Correspondence to A. Moghaddam.

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Moghaddam, A., Lennert, A., Studier-Fischer, S. et al. Endoprothesenversorgung nach Radiusköpfchentrümmerfrakturen. Unfallchirurg 111, 997–1004 (2008). https://doi.org/10.1007/s00113-008-1514-9

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  • DOI: https://doi.org/10.1007/s00113-008-1514-9

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