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Behandlungsalgorithmus der Kahnbeinpseudarthrose

Eine retrospektive radiologische Fall-Kontroll-Studie von 208 Patienten

Treatment algorithm for scaphoid nonunion

Retrospective case-control study of 208 patients

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Zusammenfassung

Hintergrund

Im Rahmen einer retrospektiven Nachuntersuchung sollen die Behandlungsergebnisse von 208 Kahnbeinpseudarthrosen dargestellt und mit der aktuellen Literatur verglichen werden.

Material und Methode

Im Rahmen einer retrospektiven Fall-Kontroll-Studie wurden zwischen 2000 und 2006 insgesamt 208 Patienten mit operativ versorgter Kahnbeinpseudarthrose radiologisch nachuntersucht. Die Unterteilung der Patienten erfolgte nach der Lokalisation der Kahnbeinpseudarthrose: distales Drittel (n=10), mittleres Drittel (n=105) und proximales Drittel (n=93). Bei Vorliegen eines avaskulären proximalen Pols sowie bei Rezidivpseudarthrosen erfolgte als additives operatives Verfahren zusätzlich zur Pseudarthrosenresektion und Beckenkammspaninterposition die Interposition oder Apposition eines vaskularisierten Radiusspans (n=53). Die Auswertung erfolgte konventionell radiologisch, ggf. durch eine CT-Untersuchung.

Ergebnisse

Eine knöcherne Konsolidierung zeigte sich bei insgesamt 187 Patienten (89,9%). Betraf die Kahnbeinpseudarthrose das proximale Drittel (n=93), konnte bei insgesamt 83% (n=77) der Patienten eine Ausheilung erreicht werden. Bei den Patienten mit vaskularisiertem Radiusspan (n=53) zeigte sich auch bei Vorliegen eines avaskulären proximalen Pols oder einer Rezidivpseudarthrose eine Durchbauung von 81%.

Schlussfolgerung

Die Prognose der Konsolidierung einer Kahnbeinpseudarthrose unter Anwendung differenzierter Operationsverfahren wie z. B. des vaskularisierten Radiusspans ist sehr gut.

Abstract

Introduction

We present a retrospective study on different treatment options for scaphoid nonunion. The results are compared to the literature and a treatment algorithm is proposed.

Materials and methods

Based on a retrospective case-control study, 208 patients suffering from scaphoid nonunion were treated between 2000 and 2006. The patients were grouped depending on the localization of the nonunion: proximal (n=10), middle (n=105), or distal (n=93) third. In the presence of a small avascular proximal fragment, a vascularized bone graft from the distal radius was added (n=53). The determination of scaphoid healing was achieved by conventional radiographs or CT scans.

Results

Overall scaphoid healing occurred in 89.9% (n=187). For small proximal scaphoid fragments (n=93), we could show healing rates up to 83% (n=77). Using a vascularized bone graft from the distal radius, scaphoid consolidation was achieved in 81% for avascular proximal fragments and recurrent scaphoid nonunion (n=53).

Conclusion

Using sophisticated treatment options, the prognosis of scaphoid nonunions is very good.

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Authors and Affiliations

  1. Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Eberhard-Karl-Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland

    P. Jaminet, F. Werdin, M. Pfau, M. Götz, T. Manoli,  A. Rahmanian-Schwarz & H.E. Schaller

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  1. P. Jaminet
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  2. F. Werdin
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  3. M. Pfau
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Jaminet, P., Werdin, F., Pfau, M. et al. Behandlungsalgorithmus der Kahnbeinpseudarthrose. Unfallchirurg 115, 994–999 (2012). https://doi.org/10.1007/s00113-011-1956-3

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