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Orthopädie und Unfallchirurgie up2date 2023; 18(04): 313-334
DOI: 10.1055/a-1952-4905
Schultergürtel und obere Extremität

Die Klavikulafraktur

Christian D. Schenk
,
Michael J. Raschke
,
J. Christoph Katthagen
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Klavikulafrakturen sind häufig. Die Klavikula stellt die einzige knöcherne Verbindung zwischen Rumpf und Schultergürtel dar. Mehrere Bänder und Muskeln finden an ihr ihren Ansatz, zu deren Verletzung es im Rahmen eines Unfalls kommen kann. Die Wahl zwischen einer konservativen oder operativen Versorgung wird durch diverse Faktoren – u. a. Lokalisation und Schwere der Fraktur, Weichteilverletzung, Dislokationsgrad, funktioneller Anspruch und operatives Risiko – beeinflusst.
Kernaussagen

  • Klavikulafrakturen gehören zu den häufigsten Frakturen.

  • Zu einer vollständigen Diagnostik zählen neben der körperlichen Untersuchung mit Inspektion, Palpation, Auskultation und Überprüfung der peripheren Durchblutung, Motorik und Sensibilität (pDMS) die Anfertigung eines Röntgenbildes der betroffenen Klavikula in 2 Ebenen sowie ggf. erweiternde Untersuchungen wie beispielsweise die Farb-Doppler-Sonografie oder CT-Angiografie bei Verdacht auf Gefäßbeteiligung oder die CT-Bildgebung im Revisionsfall bei ausbleibender Frakturheilung oder medialer Pathologie mit Einbeziehung des SC-Gelenks.

  • Wichtige Differenzialdiagnosen wie AC- und SC-Gelenkverletzungen sollten immer mitbedacht werden.

  • Kein Behandlungsverfahren ohne eigene Nachteile. Die Therapieentscheidung sollte immer individuell unter Berücksichtigung aller Faktoren wie z. B. Dislokationsgrad, Komplexität der Fraktur, Lokalisation der Fraktur, Alter des Patienten und funktionellem Anspruch getroffen werden.

  • Als therapeutische Optionen stehen einfache Plattenosteosynthesen, Doppelplattenosteosynthesen, Hakenplatten, ESIN (elastische stabile intramedulläre Nagelung) und Fadenzugsysteme zur Verfügung.

  • Bei lateralen Frakturen der Klavikula sollte stets eine Pathologie der CC-Bänder mitbedacht werden.

  • Grundsätzlich lassen sich, eine entsprechende Eignung der Fraktur und der Begleitumstände vorausgesetzt, auch durch die konservative Therapie sehr gute Ergebnisse erzielen.

Schlüsselwörter

Schultergürtel - Klavikulafraktur - Behandlung - Sternoklavikulargelenk - Akromioklavikulargelenk


Publication History

Article published online:
04 August 2023

© 2023. Thieme. All rights reserved.

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