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Handchir Mikrochir Plast Chir 2007; 39(1): 9-18
DOI: 10.1055/s-2007-964919
Übersichtsartikel

Georg Thieme Verlag KG Stuttgart · New York

Die fehlverheilte distale Radiusfraktur - Biomechanik und operative Behandlungsmöglichkeiten

Malunited Fractures of the Distal Radius - Biomechanics and Operative Treatment OptionsK.-J. Prommersberger1 , K. Kalb1 , J. van Schoonhoven1
  • 1Klinik für Handchirurgie, Rhön-Klinikum AG, Bad Neustadt/Saale
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Publication History

eingereicht 10.12.2006

akzeptiert 11.12.2006

Publication Date:
02 April 2007 (online)

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Zusammenfassung

Trotz aller Fortschritte in der Behandlung der distalen Radiusfraktur ist die Ausheilung in Fehlstellung weiterhin eine der häufigsten Komplikationen. Auch wenn nicht alle fehlverheilten Radiusfrakturen zu Beschwerden führen, so klagen doch die meisten betroffenen Patienten über eine Einschränkung der Handgelenkbeweglichkeit und Unterarmdrehung, eine verminderte Griffkraft und Schmerzen. Dies sollte Anlass für eine sorgfältige klinische Untersuchung und penible Auswertung der Röntgenaufnahmen sein und gegebenenfalls zu einer weiteren Diagnostik führen. Die Palette der Behandlungsmöglichkeiten reicht von Operationen, die lediglich der Schmerzreduktion dienen, über Eingriffe, die die Funktion verbessern, ohne die Fehlstellung zu beseitigen, bis hin zu Eingriffen, deren Ziel die weitgehende Wiederherstellung der anatomischen Verhältnisse am Handgelenk ist, allen voran die Radiuskorrekturosteotomie. Die Radiuskorrekturosteotomie führt zu einer signifikanten Verbesserung der Handgelenk- und Unterarmfunktion, der groben Kraft und zu einer deutlichen Reduktion der Schmerzen. Die Resultate sind umso günstiger, je besser das radiologische Ergebnis ausfällt.

Abstract

Despite all progress in the treatment of distal radius fractures, malunion is still one of the most common complications. It may be true that not all non-anatomically aligned fractures of the distal radius are causing disabilities. However, most patients with a distal radial malunion complain about loss of wrist motion and forearm rotation, loss of grip strength, and pain. These complaints should lead to a sophisticated clinical examination and a careful evaluation of the radiographs of the wrist, and - if needed - to further investigations. Treatment options are procedures solely aimed to diminish pain, procedures aimed to improve wrist and forearm function without restoration of the anatomic relationships, and procedures aimed to restore the anatomy of the wrist joint, especially corrective osteotomy of the radius. Radial corrective osteotomy improves significantly wrist and forearm function, grip strength, and diminishes pain. The clinical results are as good or better than the radiological results.

Schlüsselwörter

fehlverheilte Radiusfraktur - Radiuskorrekturosteotomie - radio‐skapho‐lunäre Fusion - Handgelenkdenervation

Key words

malunion of the distal radius - corrective osteotomy of the distal radius - radio‐scapho‐lunate fusion - wrist denervation

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Priv.-Doz. Dr. med. Karl-Josef Prommersberger

Klinik für Handchirurgie

Salzburger Leite 1

97615 Bad Neustadt/Saale

Email: hael@handchirurgie.de

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