Zusammenfassung
In der Behandlung der frischen Skaphoidfraktur zeichnet sich ein Wandel des Therapiestandards von der konservativen hin zur operativen Behandlung ab. In einer retrospektiven Studie sollen die bewährte offene Reposition und Verschraubung mit einer perkutanen Methode in Bezug auf den Outcome und den Patientenkomfort verglichen werden. Patienten: 19 offen versorgte Patienten mit frischen Skaphoidfrakturen werden mit 18 Patienten verglichen, die perkutan verschraubt wurden (Martini-Score, DASH). Ergebnisse: Es gibt keine statistisch signifikanten Unterschiede des Outcome in Bezug der Bewegungs- oder Kraftmessung. Durch kürzere Krankheitsdauer scheint die perkutane Verschraubung das patientenfreundlichere Verfahren zu sein. Schlussfolgerung: Perkutane und offene Verfahren stellen keine konkurrierenden, sondern ergänzende Verfahren dar. Bei Repositionshindernissen oder sonstigen Problemen muss ein Umsteigen auf das offene Verfahren möglich sein.
Abstract
Within treatments of fresh scaphoid fractures, a change of therapy standards from conservative to surgical treatment is recognizable. The proven open reposition and screw fixtures using a percutane method in regard to the outcome and patients comfort are to be compared in a retrospective study. Patients: 19 openly treated patients with fresh scaphoid fractures are compared to 18 patients with percutaneously screw fixtures (MARTINI-Score, DASH). Results: There are no statistically significant differences of the outcome in regard to movement- or strength measures. Due to shorter courses of illness a percutaneously screw fixture seems to be the more comforting treatment for patients. Conclusion: Percutaneous and open treatments are not competing methods, but rather supplementary treatments. For occurring reposition hindrances or other possibly occurring problems converting must be possible.
Literatur
-
1
Adolfsson L, Lindau T, Arner M.
Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.
J Hand Surg (Br).
2001;
26
192-195
-
2
Bickert B, Baumeister S, Sauerbier M. et al .
(Use of a cannulated 3.0 mm AO screw with an intraosseous support washer in osteosynthesis of the scaphoid: results and analysis of problems in 28 cases.).
Handchir Mikrochir Plast Chir.
2000;
32
277-282
-
3 Böhler L. Die Technik der Knochenbruchbehandlung in Frieden und im Kriege. Wien; Wilhelm Maudrich 1943
-
4
Bond C D, Shin A Y, McBride M T. et al .
Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures.
J Bone Joint Surg Am.
2001;
83
483-488
-
5
Brauer R B, Dierking M, Werber K D.
(Use of the Herbert screw with the freehand method for osteosynthesis of acute scaphoid fracture.).
Unfallchirurg.
1997;
100
776-781
-
6
Christodoulou L, Chamberlain S T.
Internal fixation of scaphoid fractures with an AO mini-fragment lag screw, using temporary interoperative AO mini external fixation.
J Hand Surg (Br).
1999;
24
676-678
-
7
Cooney W P.
Herbert screw fixation of scaphoid fractures.
J Bone Joint Surg Br.
1998;
80
181-182
-
8
Ehrendorfer S.
The anatomy of acute scaphoid fractures.
J Bone Joint Surg Br.
1998;
80
933
-
9
Eisenschenk A, Lautenbach M, Weber U.
Scaphoidfrakturen und Scaphoidpseudarthrosen.
Orthopäde.
1999;
10
883-890
-
10
Geissler W B, Hammit M D.
Arthroscopic aided fixation of scaphoid fractures (In Process Citation).
Hand Clin.
2001;
17
575-588
-
11
Gunal I.
Acute fractures of the scaphoid.
J Bone Joint Surg Br.
1999;
81
934
-
12
Haddad F S, Goddard N J.
Acute percutaneous scaphoid fixation. A pilot study.
J Bone Joint Surg Br.
1998;
80
95-99
-
13
Haddad F S, Goddard N J.
Acute percutaneous scaphoid fixation using a cannulated screw.
Chir Main.
1998;
17
119-126
-
14
Hambidge J E, Desai V V, Schranz P J. et al .
Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension?.
J Bone Joint Surg Br.
1999;
81
91-92
-
15 Herbert T J. The Fractured Scaphoid. St. Louis; Quality Medical Publishing 1990
-
16
Herbert T J.
Open volar repair of acute scaphoid fractures (In Process Citation).
Hand Clin.
2001;
17
589-599
-
17
Inoue G, Shionoya K.
Herbert screw fixation by limited access for acute fractures of the scaphoid.
J Bone Joint Surg Br.
1997;
79
418-421
-
18
Jupiter J B, Shin A Y, Trumble T E. et al .
Traumatic and reconstructive problems of the scaphoid.
Instr Course Lect.
2001;
50
105-122
-
19
Kozin S H.
Internal fixation of scaphoid fractures.
Hand Clin.
1997;
13
573-586
-
20
Mack G R, Wilckens J H, McPherson S A.
Subacute scaphoid fractures. A closer look at closed treatment.
Am J Sports Med.
1998;
26
56-58
-
21
Martini A K.
Der Spontanverlauf der Kahnbeinpseudarthrose.
Orthopäde.
1994;
23
249-254
-
22
Rettig A C.
Management of acute scaphoid fractures.
Hand Clin.
2000;
16
381-395
-
23
Rettig M E, Kozin S H, Cooney W P.
Open reduction and internal fixation of acute displaced scaphoid waist fractures.
J Hand Surg (Am).
2001;
26
271-276
-
24
Ring D, Jupiter J B, Herndon J H.
Acute fractures of the scaphoid.
J Am Acad Orthop Surg.
2000;
8
225-231
-
25
Roesgen M, Hierholzer G.
Die klinische Problematik der Kahnbeinfraktur.
Unfallchirurg.
1988;
14
139-147
-
26
Roesgen M, Hierholzer G.
Osteosynthesen im Bereich der Handwurzel.
OP-Journal.
1991;
2
50-54
-
27
Saeden B, Tornkvist H, Ponzer S. et al .
Fracture of the carpal scaphoid. A prospective, randomised 12-year follow-up comparing operative and conservative treatment.
J Bone Joint Surg Br.
2001;
83
230-234
-
28
Schadel-Hopfner M, Bohringer G, Gotzen L.
(Percutaneous osteosynthesis of scaphoid fracture with the Herbert-Whipple screw-technique and results).
Handchir Mikrochir Plast Chir.
2000;
32
271-276
-
29
Slade J F, Grauer J N, Mahoney J D.
Arthroscopic reduction and percutaneous fixation of scaphoid fractures with a novel dorsal technique.
Orthop Clin North Am.
2001;
32
247-261
-
30
Slade J F, Jaskwhich D.
Percutaneous fixation of scaphoid fracutres (In Process Citation).
Hand Clin (United States).
2001;
17
553-574
-
31 Studtmann V, Rudolph H. Die Behandlung der Scaphoidfraktur. In: Rahmanzadeh R, Meißner A, Würtenberger C, Fell M Unfall- und Wiederherstellungschirurgie des Unterarmes. Reinbeck; Einhorn-Presse Verlag 1996
-
32
Toby E B, Butler T E. et al .
A Compaison of Fixation Screws for the Scaphoid during Application of Caclical Bending Loads.
JBJS.
1997;
79
1190-1197
-
33
Trumble T E, Gilbert M, Murray L W. et al .
Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw.
J Bone Joint Surg Am.
2000;
82
633-641
-
34
Willis A S.
Managing scaphoid fractures - which one is right?.
Aust Fam Physician.
2001;
30
204
Dr. J. Schmidt
HELIOS Klinikum Berlin · Unfallchirurgische Klinik
Hobrechtsfelder Chaussee 100 · 13125 Berlin
Phone: 030/9401-7669
Fax: 030/9401-7174
Email: jschmidt@berlin.helios-kliniken.de
