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Arthroskopisch unterstützte Frakturversorgung am Handgelenk

Arthroscopy-assisted management of wrist fractures

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Zusammenfassung

Die distale Radiusfraktur ist die häufigste Fraktur des Menschen. Die operative Versorgung wird in vielen Fällen bereits als protektive Maßnahme gegen eine sekundäre Dislokation angestrebt. Somit wird in zunehmendem Maße die Indikation zur Operation gestellt. Die Versorgung konzentriert sich ausschließlich auf den ossären Aspekt, der durch die radiologische Diagnostik beurteilbar ist. Auf eine weiterführende Diagnostik der Weichteilstrukturen und des Gelenkknorpels wird bis heute weitestgehend verzichtet, obwohl die zur Fraktur führende Energie in vielen Fällen das Potential zur Verletzung weiterer Strukturen hat. Die zunehmende Verbreitung der Handgelenkarthroskopie eröffnet hinsichtlich intraartikulärer Begleitverletzungen neue Möglichkeiten. Eine assistierte Frakturreposition unter direkter visueller Darstellung erlaubt sowohl die Mitversorgung etwaiger Diskus- oder Ligamentverletzungen als auch ein ausgedehntes Débridement und die Entfernung von freien Gelenkkörpern.

Abstract

Distal radius fractures are the most common fractures in humans and early surgical intervention with modern plating systems is becoming increasingly more established to avoid secondary dislocation. Even fractures with slight dislocations are adequately stabilized and the affinity for surgical intervention and plating procedures is applied to secure these simple fractures. In this aspect the surgical indications are significantly dependent on X-ray examination results. Further diagnostics with respect to ligamentous and soft tissue injury are the exception although the impact energy which creates osseus fractures is sufficient by far to destroy functional soft tissue, cartilage and ligaments. The ongoing development of wrist arthroscopy enables new possibilities especially concerning concomitant articular involvement of distal radius fractures. Arthroscopy-assisted reduction and stabilization as well as minimally invasive soft tissue repair and loose body removal seem to be adequate methods to improve the surgical treatment of distal radius fractures.

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  1. Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 80809, München, Deutschland

    S. Deiler, S. Häberle, P. Quentmeier, P. Biberthaler & P. Ahrens

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  1. S. Deiler
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  2. S. Häberle
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  3. P. Quentmeier
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  4. P. Biberthaler
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Correspondence to S. Deiler.

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Deiler, S., Häberle, S., Quentmeier, P. et al. Arthroskopisch unterstützte Frakturversorgung am Handgelenk. Unfallchirurg 116, 305–310 (2013). https://doi.org/10.1007/s00113-012-2348-z

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