Digitale Volumentomografie bei der Behandlung von Radiusfrakturen

 

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Zusammenfassung

Die digitale Volumentomografie (DVT) bietet in der Handchirurgie eine relativ neue Form der Schnittbildgebung. Die distale Radiusfraktur nimmt als häufigste Fraktur des Erwachsenen einen besonderen Stellenwert ein, nicht nur für Handchirurgen. Das Patientenaufkommen ist hoch und es bedarf schneller und valider Diagnostik. Operative Techniken und Möglichkeiten werden stetig weiterentwickelt, insbesondere was intraartikuläre Frakturen betrifft. Der Anspruch auf exakte Versorgung ist hoch. Bei der Indikation einer präoperativen dreidimensionalen Bildgebung besteht weitestgehend Einigkeit und sie findet häufig Anwendung. Üblicherweise erfolgt sie mittels Mehrzeilen-Spiral-CT (Multidetektor-CT, MDCT). Die postoperative Bildgebung beschränkt sich in den meisten Fällen auf konventionelle Röntgenbilder in zwei Ebenen. Allgemein akzeptierte Empfehlungen bezüglich einer postoperativen 3D-Bildgebung existieren bisher nicht. Die Datenlage ist spärlich. Sollte eine CT indiziert sein, so wird diese üblicherweise ebenfalls mittel MDCT durchgeführt. Die DVT-Diagnostik im Bereich des Handgelenkes ist noch wenig verbreitet. Diese Arbeit beschäftigt sich mit dem möglichen Einsatz der DVT in der perioperativen Diagnostik distaler Radiusfrakturen. Die DVT ermöglicht eine exzellente Bildqualität bei potentiell niedrigerer Strahlenbelastung im Vergleich zur MDCT, mit und ohne einliegendem Osteosynthesematerial. Sie ist schnell verfügbar und eigenständig durchführbar, was zeitsparend und effizient ist und damit den klinischen Alltag erleichtert. Durch ihre vielen Vorteile stellt die DVT bei der perioperativen Diagnostik von Radiusfrakturen eine empfehlenswerte Alternative zum MDCT dar.

Abstract

Cone-beam computed tomography (CBCT) is a relatively new imaging technique in hand surgery. Being the most common fractures in adults, distal radius fractures are of special importance not only to hand surgeons. The quantity alone calls for fast, efficient and reliable diagnostic procedures. Surgical techniques and possibilities are progressing, especially regarding intra-articular fracture patterns. The demand for exact anatomic reduction is high. There is an overall consensus regarding the indication for preoperative three-dimensional imaging and it is frequently used. Typically, it is obtained by multi-detector computed tomography (MDCT). Postoperative diagnostic procedures are usually limited to plain x-rays. Commonly accepted recommendations regarding postoperative 3D imaging are not yet established. There is a lack of relevant literature. In case of an indication for a postoperative CT scan, it is generally also obtained by MDCT. CBCT for the wrist is not widely used as yet. This review focuses on the potential role of CBCT in the perioperative management of distal radius fractures. CBCT allows for high-resolution imaging with a potentially lower radiation dose compared with MDCT, both with and without implants. It is easily available and can be operated independently, thus being time-efficient and making daily practice easier. Due to its many advantages, CBCT is a recommendable alternative to MDCT in the perioperative management of distal radius fractures.

Publication History

Received: 03 March 2023

Accepted: 12 March 2023

Article published online:
12 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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