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Posttraumatische Komplikationen am kindlichen Ellenbogen

Posttraumatic complications on children’s elbows

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Zusammenfassung

Die häufigsten Frakturen im Wachstumsalter betreffen die obere Extremität. Vor allem nach ellenbogengelenknahen Frakturen kommt es oft zu Komplikationen. Die Fugen um das Ellenbogengelenk sind am Längenwachstum nur mit 20% beteiligt und besitzen daher nur ein geringes Korrekturpotenzial. Auch die Möglichkeit der Spontankorrektur ist bereits mit dem 7. Lebensjahr ausgeschöpft. Die Konsequenzen einer unzureichend versorgten, ellenbogennahen Fraktur können den Patienten somit ein Leben lang begleiten. Für den behandelnden Chirurgen sind posttraumatische Fehlstellungen am kindlichen Ellenbogen eine Herausforderung. Häufig sind sie die Folge einer unzureichenden Primärtherapie und selten auf Wachstumsstörungen zurückzuführen. Die häufigste posttraumatische Fehlstellung ist der Cubitus varus, gefolgt vom Cubitus valgus. Beide Deformitäten können aus einer ungenügend behandelten suprakondylären Humerusfraktur, einer Condylus-radialis-Fraktur oder einer übersehenen Luxation des Radiusköpfchens resultieren.

Abstract

Most fractures during growth affect the upper extremities. Severe fractures with an increased number of complications are mainly localized beyond the elbow joint. Displaced fractures of the elbow joint have limited potential for spontaneous correction as the bones near the elbow joint account for only 20% of growth in length and the possibility of spontaneous correction is already exhausted at the age of 7. The consequences of inadequately reduced elbow fractures, therefore, may adversely affect a patient for his lifetime. Cubitus varus and valgus are the most common deformities following insufficiently treated supracondylar humerus fractures, fractures of the radial or dislocations of the radial head. Posttraumatic deformities of the elbow are usually the result of an insufficient primary therapy and rarely the result of growth disturbances. For the attending surgeon, posttraumatic deformities on a child’s elbow are challenging.

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Literatur

  1. Laer L von (1979) Die supracondyläre Humerusfraktur im Kindesalter. Arch Orthop Trauma Surg 95:123

    Article  Google Scholar 

  2. Laer L von, Kraus R, Linhart W (2007) Frakturen und Luxationen im Wachstumsalter. Thieme, Stuttgart New York

  3. Raney EM, Thielen Z, Gregory S, Sobralske M (2012) Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop 32(3):232–240

    Article  PubMed  Google Scholar 

  4. Chambers K, Wilkins K (1996) Dislocations of the joints of the elbow. In: Rockwood C, Wilkins K, Beaty J (Hrsg) Fractures in children. Lippincott-Raven, Philadelphia, S 840–1020

  5. Cheng J (2001) Epidemiological features of supracondylar fractures in children. J Pediatr Orthop 10:63–67

    CAS  Google Scholar 

  6. Gaddy BC, Manske PR, Pruitt DL et al (1994) Distal humeral osteotomy for correction of posttraumatic cubitus varus. J Pediatr Orthop 14(2):214–219

    Article  PubMed  CAS  Google Scholar 

  7. Hasler CC, Laer L von, Hell AK (2005) Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Joint Surg Br 87(1):88–94

    PubMed  CAS  Google Scholar 

  8. Karatosun V, Alekberov C, Alici E et al (2000) Treatment of cubitus varus using the Ilizarov technique of distraction osteogenesis. J Bone Joint Surg Br 82(7):1030–1033

    Article  PubMed  CAS  Google Scholar 

  9. Slongo T, Fernandez FF (2011) Die fehlverheilte Monteggia-Verletzung im Kindes- und Jugendalter. Unfallchirurg 114(4):311–322

    Article  PubMed  CAS  Google Scholar 

  10. Kasser J, Beaty J (2001) Supracondylar fractures of the distal humerus. In: Wilkins RA (Hrsg) Fractures in children. Lippincott Williams & Wilkins, Philadelphia

  11. Bellemore MC, Barrett IR, Middleton RW et al (1984) Supracondylar osteotomy of the humerus for correction of cubitus varus. J Bone Joint Surg Br 66(4):566–572

    PubMed  CAS  Google Scholar 

  12. De Boeck H, De Smet P (1997) Valgus deformity following supracondylar elbow fractures in children. Acta Orthop Belg 63(4):240–244

    Google Scholar 

  13. Koch PP, Exner GU (2003) Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformity. J Pediatr Orthop B 12(2):116–122

    PubMed  Google Scholar 

  14. Levine MJ, Horn BD, Pizzutillo PD (1996) Treatment of posttraumatic cubitus varus in the pediatric population with humeral osteotomy and external fixation. J Pediatr Orthop 16(5):597–601

    Article  PubMed  CAS  Google Scholar 

  15. Beaty J, Kasser J (2006) Supracondylar fractures of the distal humerus. In: Wilkins RA (Hrsg) Fractures in children. Lippincott Williams & Wilkins, Philadelphia, S 577–572

  16. Kim HT, Lee JS, Yoo CI (2005) Management of cubitus varus and valgus. J Bone Joint Surg Am 87(4):771–780

    Article  PubMed  Google Scholar 

  17. Laer L von (2007) Condylus radialis Frakturen. In: Laer L von, Kraus R, Linhart W (Hrsg) Frakturen und Luxationen im Wachstumsalter. Thieme, Stuttgart New York, S 242–247

  18. Kumar K, Sharma VK, Sharma R, Maffulli N (2000) Correction of cubitus varus by French or dome osteotomy: a comparative study. J Trauma 49(4):717–721

    Article  PubMed  CAS  Google Scholar 

  19. Takeyasu Y, Murase T, Miyake J et al (2011) Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg 20(3):440–448

    Article  PubMed  Google Scholar 

  20. Wilkins K, Beaty J, Chambers H, Toniolo M (1996) Fractures and dislocations of the elbow region. In: Wilkins K, Beaty J, Chambers H (Hrsg) Fractures in children. Lippincott-Raven, Phildelphia, S 653–904

  21. Rang M (1974) Fractures in children. Lippincott, Philadelphia

  22. Laer L von (1981) Fracture of the condylus radialis humeri during skeletal growth. Arch Orthop Trauma Surg 98:275–283

    Article  Google Scholar 

  23. Wilkins K (1990) Residuals of elbow trauma in children. Orthop Clin North Am 21:291–314

    PubMed  CAS  Google Scholar 

  24. Morissy R, Weinstein S (2001) Atlas of pediatric orthopedic surgery. Lippincott Williams & Wilkins, Philadelphia

  25. David-West KS, Wilson NI, Sherlock DA, Bennet GC (2005) Missed Monteggia injuries. Injury 36(10):1206–1209

    Article  PubMed  Google Scholar 

  26. Degreef I, De Smet L (2004) Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy. J Orthop Trauma 18(6):375–378

    Article  PubMed  CAS  Google Scholar 

  27. Fowles JV, Sliman N, Kassab MT (1983) The Monteggia lesion in children. Fracture of the ulna and dislocation of the radial head. J Bone Joint Surg Am 65(9):1276–1282

    PubMed  CAS  Google Scholar 

  28. Gicquel P, De Billy B, Karger C et al (2000) Treatment of neglected Monteggia’s fracture by ulnar lengthening using the Ilizarov technique. Rev Chir Orthop Reparatrice Appar Mot 86(8):844–847

    PubMed  CAS  Google Scholar 

  29. Eberl R, Weinberg AM (2010) Operative corrections of posttraumatic deformities of the elbow joint in children. Unfallchirurg 113(2):139–148

    Article  PubMed  CAS  Google Scholar 

  30. Linhart W, Kraus T (2008) Korrekturosteotomien supracondylärer Fehlstellungen am Humerus. Oper Orthop Traumatol 4(5):396–408

    Article  Google Scholar 

  31. Handelsman JE, Weinberg J, Hersch JC (2006) Corrective supracondylar humeral osteotomies using the small AO external fixator. J Pediatr Orthop B 15(3):194–197

    Article  PubMed  Google Scholar 

  32. Matsushita T, Nagano A (1997) Arc osteotomy of the humerus to correct cubitus varus. Clin Orthop Relat Res 336:111–115

    Article  PubMed  Google Scholar 

  33. Bali K, Sudesh P, Krishnan V et al (2011) Modified step-cut osteotomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res 97(7):741–749

    Article  PubMed  CAS  Google Scholar 

  34. Al-Sayyad MJ (2012) Taylor spatial frame in the treatment of upper extremity conditions. J Pediatr Orthop 32(2):169–178

    Article  PubMed  Google Scholar 

  35. Davids JR, Lamoreaux DC, Brooker RC et al (2011) Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop 31(4):353–365

    Article  PubMed  Google Scholar 

  36. Leggiadro VE (1948) Guide for drill osteotomy. J Bone Joint Surg Am 30A(3):786

    PubMed  CAS  Google Scholar 

  37. Laer L von (2004) Surgical correction of the upper and lower arm of children. Unfallchirurg 107(7):552–562

    Article  Google Scholar 

  38. Bell Tawse A (1965) The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg Br 47:718–723

    Google Scholar 

  39. Bucknill TM (1977) Anterior dislocation of the radial head in children. Proc R Soc Med 70(9):620–624

    PubMed  CAS  Google Scholar 

  40. Cappellino A, Wolfe SW, Marsh JS (1998) Use of a modified Bell Tawse procedure for chronic acquired dislocation of the radial head. J Pediatr Orthop 18(3):410–414

    PubMed  CAS  Google Scholar 

  41. Lloyd-Roberts GC, Bucknill TM (1977) Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Joint Surg Br 59-B(4):402–407

    Google Scholar 

  42. Oner FC, Diepstraten AF (1993) Treatment of chronic post-traumatic dislocation of the radial head in children. J Bone Joint Surg Br 75(4):577–581

    PubMed  CAS  Google Scholar 

  43. Papandrea R, Waters PM (2000) Posttraumatic reconstruction of the elbow in the pediatric patient. Clin Orthop Relat Res 370:115–126

    Article  PubMed  Google Scholar 

  44. Eygendaal D, Hillen RJ (2007) Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. Strategies Trauma Limb Reconstr 2(1):31–34

    Article  PubMed  CAS  Google Scholar 

  45. Slongo TF (2008) Correction osteotomy of neglected „Monteggia“ lesion with an external fixator. Oper Orthop Traumatol 20(4-5):435–449

    Google Scholar 

  46. Futami T, Tsukamoto Y, Fujita T (1992) Rotation osteotomy for dislocation of the radial head. 6 cases followed for 7 (3–10) years. Acta Orthop Scand 63(4):455–456

    Article  PubMed  CAS  Google Scholar 

  47. Witt AN (1965) Die transartikuläre Fixation bei Frakturen und Luxationen im Bereich des Humeroradialgelenkes. In: Maurer G (Hrsg) Chirurg im Fortschritt. Enke, Stuttgart

  48. Vocke AK, Laer L von (1998) Displaced fractures of the radial neck in children: long-term results and prognosis of conservative treatment. J Pediatr Orthop B 7(3):217–222

    Article  PubMed  CAS  Google Scholar 

  49. Wang MN, Chang WN (2006) Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma 20(1):1–5

    Article  PubMed  Google Scholar 

  50. Rodgers WB, Waters PM, Hall JE (1996) Chronic Monteggia lesions in children. Complications and results of reconstruction. J Bone Joint Surg Am 78(9):1322–1329

    PubMed  CAS  Google Scholar 

  51. Seel MJ, Peterson HA (1999) Management of chronic posttraumatic radial head dislocation in children. J Pediatr Orthop 19(3):306–312

    PubMed  CAS  Google Scholar 

  52. Villa A, Paley D, Catagni MA et al (1990) Lengthening of the forearm by the Ilizarov technique. Clin Orthop Relat Res 250:125–137

    PubMed  Google Scholar 

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  1. Abteilung für Kinderorthopädie, Universitätsklinik für Kinderchirurgie, Medizinische Universität Graz, Auenbruggerplatz 34, 8036, Graz, Österreich

    T. Kraus, S. Tauber & W. Linhart

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  1. T. Kraus
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  2. S. Tauber
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  3. W. Linhart
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Correspondence to T. Kraus.

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Kraus, T., Tauber, S. & Linhart, W. Posttraumatische Komplikationen am kindlichen Ellenbogen. Orthopäde 42, 57–70 (2013). https://doi.org/10.1007/s00132-012-2029-1

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  • DOI: https://doi.org/10.1007/s00132-012-2029-1

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