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Z Orthop Unfall 2011; 149(6): e69-e88
DOI: 10.1055/s-0031-1280424
Refresher Orthopädie und Unfallchirurgie
Rubrikherausgeber: R. Hoffmann, Frankfurt; R. Windhager, Graz
© Georg Thieme Verlag KG Stuttgart · New York

Radiuskopf- und Radiushalsfrakturen

Fractures of the Radial Head and NeckK. Schmidt-Horlohé1 , S. Siebenlist2 , U. Stöckle3 , J. Pichl1 , R. Hoffmann1
  • 1Abteilung für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main
  • 2Klinikum rechts der Isar, Abteilung für Unfallchirurgie, TU München, München
  • 3Klinik für Unfall und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen
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Publikationsdatum:
08. Dezember 2011 (online)

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Zusammenfassung

Radiuskopf- und Radiushalsfrakturen stellen – mit einem Anteil von 5 % an allen Frakturen und von einem Drittel an allen knöchernen Ellenbogengelenksverletzungen – eine häufige Entität dar. Aufgrund der komplexen funktionellen Anatomie des Ellenbogengelenks und den häufig mehrfragmentären Fraktursituationen mit destabilisierenden Begleitverletzungen stellt sie eine Herausforderung für den behandelnden Unfallchirurgen dar. Detaillierte Kenntnisse von Anatomie und Biomechanik sind essenziell für Analyse, Verständnis und Therapieplanung. Ziel der differenzierten Therapie ist das Wiederherstellen von Anatomie und Gelenkkinematik, eine stabile und schmerzfreie Gelenkfunktion sowie das Verhindern/Verzögern von posttraumatischen Gelenkveränderungen. Das therapeutische Spektrum reicht von der konservativen Behandlung mit kurzzeitiger Ruhigstellung bei einfachen Frakturen, über die offene Reposition mit isolierter Schraubenosteosynthese bis hin zu komplex rekonstruktiven Maßnahmen kombinierter Schrauben- und Plattenosteosynthese, Teilresektion oder endoprothetischem Radiuskopfersatz bei mehrfragmentären Komplexfrakturen. Der vorliegende CME-Refresher vermittelt einen detaillierten Überblick über Anatomie, Biomechanik und Pathomechanismen. Neben der Darstellung der diagnostischen Möglichkeiten werden die operativen Zugangswege beschrieben und die konservative und operative Therapie veranschaulicht.

Abstract

Fractures of the radial head and neck are the most common involving the elbow and account for 5 % of all fractures in adult individuals. Due to the complex anatomy and biomechanics of the elbow joint radial head fractures are challenging, particularly the comminuted ones. Detailed knowledge of the complex joint anatomy, biomechanics and operative approaches are indispensable for analysing and building a treatment plan. The aim of radial head fracture treatment is to restore the anatomy and joint kinematics, achieve a stable and pain-free range-of-motion and to avoid posttraumatic degenerative changes. Treatment depends on the type of fracture and accompanying injuries. It ranges from conservative treatment with early initiation of physical therapy to open reduction and internal fixation. Sophisticated reconstructive efforts with combined screw- and plate-osteosynthesis, partial resection or radial head arthroplasty are needed in comminuted fractures. The purpose of this article is to give a detailed review of the anatomy, biomechanics and fracture mechanism. Clinical examination techniques are displayed and operative approaches as well as the conservative and operative treatment algorithms are illustrated.

Key words

Radiuskopf - Fraktur - Mason - konservative Therapie - Osteosynthese - Prothese

Key words

radial head - fracture - Mason - conservative treatment - open reduction and internal fixation - radial head arthroplasty

Literaturverzeichnis als PDF

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Dr. med. Kay H. Schmidt-Horlohé

Berufsgenossenschaftliche Unfallklinik Frankfurt am Main
Abteilung für Unfallchirurgie und orthopädische Chirurgie

Friedberger Landstraße 430

60389 Frankfurt am Main

eMail: kay.schmidt-horlohe@bgu-frankfurt.de