Zusammenfassung
Wachstumsphänomene nach Vorderarmfrakturen bei noch offenen Fugen werden beschrieben. Die Potenz zur Spontankorrektur von Fehlstellungen nach Frakturen am wachsenden Skelett soll zur Vermeidung unnötiger Manipulationen, Anästhesien und posttraumatischen Fehlstellungen in die Primärtherapie einbezogen werden. Generell sprechen genügendes Restwachstum, Nähe zu einer hochprozentigen Fuge und Deformität in der Hauptbewegungsebene des nächstgelegenen Gelenkes für eine hohe Korrekturpotenz. Während handgelenknahe Fehlstellungen von Radius und/oder Ulna bis zum Alter von 11 bis 12 Jahren anstandslos korrigiert werden, ist die Toleranz bei Fehlstellungen des proximalen und mittleren Schaftdrittels geringer und auch weniger gut bekannt. Stimulative Wachstumsstörungen sind an der oberen Extremität klinisch unbedeutend. Hemmende Wachstumsstörungen nach Fugenverschlüssen sind selten und weder aus der Art der Läsion noch aus dem Ausmaß der Dislokation prognostizierbar.
Summary
Growth phenomena after paediatric forearm fractures are described. The capacity for spontaneous remodelling of malunions should be primarily considered in the treatment of fractures of the growing skeleton. Thus, unnecessary reductions, anaesthesia and posttraumatic deformities can be prevented. Generally speaking, a high remodelling capacity can be expected in cases of enough remaining growth, proximity to a physis with high activity, and if the main deformity lies in the plane of motion of the nearest joint. It is widely accepted that distal radius and/or ulna fractures are fully remodelled up to the age of 11 to 12 years. However, the remodelling capacity of fractures of the proximal and middle third of the shaft is smaller and less well known. Stimulating growth disturbances at the upper extremities are clinically of minor importance. Growth arrests are rare. Their fateful occurrence is not predictable and not closely related to fracture pattern or amount of dislocation.
Schlüsselwörter
Frakturen: Unterarm - Wachstumsalter - Fehlstellung - Spontankorrektur - Wachstumsstörung
Key words
Fractures: forearm - children - malunion - spontaneous remodelling - growth disturbances
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1 Nach einem Vortrag auf dem 39. Symposium der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie vom 14. bis 17. Oktober 1998 in Innsbruck.
Prof. Dr. med. Lutz von Laer
Universitäts-Kinderspital Beider BaselTraumatologische Abteilung der Kinderorthopädischen Klinik
Postfach
Römergasse 8
4005 Basel
Schweiz
