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Handchirurgie Scan 2021; 10(03): 215-235
DOI: 10.1055/a-1430-4980
CME-Fortbildung

Die Therapie des instabilen distalen Radioulnargelenkes (DRUG)

Christian K. Spies
,
Rainer Schmitt
,
Martin F. Langer
,
Peer Eysel
,
Ali Ayache
,
Frank Unglaub
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Die Bedeutung des triangulären fibrokartilaginären Komplexes (TFCC) als Stabilisator des distalen Radioulnargelenkes (DRUG) ist in zahlreichen biomechanischen Untersuchungen nachgewiesen worden. Läsionen dieses sehr präzise abgestimmten Systems können sich fatal auf die Gelenkpartner auswirken. Um eine DRUG-Instabilität zu diagnostizieren, bedarf es eines systematischen Untersuchungsablaufs, der in diesem Beitrag ebenso beschrieben wird, wie die Therapieoptionen für das instabile DRUG.
Kernaussagen

  • Die Bedeutung des TFCC als Stabilisator des DRUG ist in zahlreichen biomechanischen Untersuchungen nachgewiesen worden.

  • Oftmals ist eine DRUG-Instabilität schwer zu diagnostizieren, deswegen bedarf es eines systematischen Untersuchungsablaufs.

  • Die Beurteilung der DRUG-Stabilität in Neutralstellung, in Supination und in Pronation, jeweils im Seitenvergleich, ist essenzieller Bestandteil der klinischen Untersuchung.

  • Die röntgenologische Untersuchung zum Ausschluss knöcherner Läsionen ist notwendig.

  • Eine Rotations-CT beider Handgelenke in Supination, Neutralstellung und Pronation ist bei zweifelhaften Befunden das adäquate Mittel, um eine DRUG-Instabilität nachzuweisen.

  • Die Handgelenkspiegelung ist weiterhin der Referenzstandard zur eindeutigen Einordnung der TFCC-Läsionen.

  • Instabilitätsverursachende Rupturen der distalen radioulnaren Ligamente sollten vorzugsweise anatomisch behandelt werden.

  • Knöcherne Bandabrisse werden in der Regel mit einer Osteosynthese behandelt. Bandläsionen können sowohl durch Ankernähte als auch transossär versorgt werden.

  • Ein Sehnentransplantat ist zur Rekonstruktion der radioulnaren Bandstrukturen bei nicht refixierbaren Bandstümpfen eine sinnvolle Behandlungsoption.

  • Eine posttraumatische Achsabweichung im Schaftbereich eines der beiden Unterarmknochen ist eine mögliche Ursache einer DRUG-Instabilität, deren kausale Therapie in der Korrekturosteotomie besteht.

Schlüsselwörter

distales Radioulnargelenk - Instabilität - TFCC - bildgebende Verfahren - Therapie


Publication History

Article published online:
10 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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